Today we did something crazy. We drove from Missoula, Montana to Eureka, Montana and back to give a friend a ride back to civilization from their family’s compound after they tested negative for COVID-19. What a great chance to show everyone this amazing place I live!
I am blessed to live in a place of wide open spaces and the optical illusion that creates a bigger sky
Where glaciers collide with clouds
Flathead Lake is always a welcome sight
Flathead Lake is a gem
We hit a bit of rain on our way, but it eventually subsided.
As with any good Montana road trip you have to stop for the wildlife.
Don’t worry – they move eventually
Nearing Eureka as it begins to get darker
Blue sky still visible at 9 PM? Not for long!
Near Trego, Montana the last bits of day find their way into this beautiful night
We managed to catch the sunset on our way in to town
As I’m pleased to share with you some of the magnificent clouds we witnessed about 15 miles south of the Canadian border at the port of Roosville
As we return from Eureka we see signs reminding us to social distance and stay close to home. Missoula County and Lincoln County both have 0 active cases. Our friend safely in tow, they are also high risk, have been isolating, and need to get to Missoula for a doctor appointment that cannot be done over a video chat.
Whitefish looks desolate. There’s no one on the roads here. It makes sense – Flathead County is among the hardest hit in the state – every case that’s been traceable has been connected to travel. Flathead County is where the airport for West Glacier and Whitefish is. We head south toward Kalispell.
We stop in Kalispell to charge the car and use a disposable barrier for handling the charging cable. Charging will require a couple of hours.
It’s dark, so the pictures aren’t going to be very interesting for the rest of tonight. We will be safely back in Missoula soon.
And there’s your Montana road trip during this crazy time. The world is a mess. Stay safe – hold your family close.
This is also a good time to mention that I have a poetry collection called “One Hundred Different Skies” coming out in Summer 2020. Once I have the cover art finished I will be making the collection available for digital pre-order.
I’ve already received great feedback from a couple of beta readers and I’m loving all of it. This might sound weird, but I love hearing when someone dislikes one of my poems if they can tell me why they dislike it. I find it really helpful to me because as I’ve been working through cases where someone can tell me why they dislike something, I find that I can understand their viewpoint and am willing to edit and try to rewrite sections to improve the work.
I accept that there are few things harder than editing poetry in the world of writing. But there’s nothing more rewarding than a poem that accurately captures an experience. My beta readers are AMAZING.
As always, thank you for taking the time to read this post and if you haven’t heard it today: you are loved and you are valued.
In my personal life, I’m trying to focus on sanity and reframing my life in light of new information. I’m not ready to disclose this because the world circumstances caused a lot of things to take a nosedive into the land of waiting in uncertainty and self examination. For those within the #WritingCommunity that know more, I appreciate the privacy and support you have provided. I’m sure I will open up in time once more things come to light.
What stage of Social Isolation Insanity are you at?
In response to this picture a couple people asked if I’m okay. I promise this is me having a great time while alone and is a preview to an upcoming shenanigan.
This other picture, however, is talking about something else. I recently started feeling homesick for where I grew up. I replay the echoes of seagulls laughing off the Chesapeake Bay as skates taste my feet with confusion as they glide along the sandbars while I rake clams. As the warm waters returned with the shift in the gulf stream, so did the early morning rituals of waterman life. Standing on the back of an aluminum boat, bracing myself against the wake, I dropped crab pots off the side, each one tied to their own neon float with our family name and number marked. As we returned to the creek, the sulfur smell of estuaries warms the chest and the sea spray settles in to the early stages of sunburn this time of year. Oh, there’s that sticky, nasty, painful emotion again. I think I’ve felt it since 2011 when I moved away from the area permanently. Since then, I beat it down until I couldn’t hear that inner voice anymore and thanks to isolation it’s bubbling up. I kept following “opportunity”. Then I got married. For some reason, up until now, I always thought I’d go home.
Now, I live in Missoula, Montana in the middle of a global pandemic. Living in the middle of nowhere is a blessing. It means that besides working from home and isolating, our family spends a lot of time on our property or out and about. Montana never closed the hiking trails or parks and the campgrounds have reopened in most places. Heck, We tried to go camping this past weekend and Chief Looking Glass campground was packed!
Montana is requiring a 2 week quarantine for everyone entering the state, plus we’ve been social distancing since before it was “cool”. We are one of the few states that seems to be holding things together pretty well. We have 21 active cases in the whole state and we have expanded testing. That 1 new case is in Jefferson County.
So what happens next? Well, hopefully I’m going to post fun content that will make people smile and laugh. Maybe I’ll post something that will upset someone and that will either make me care or it won’t. We’ll see. I’m a little weird when it comes to detecting the emotions of others – sometimes they confuse me more than anything else and I need help. With that in mind, consider explaining to me what you find upsetting before jumping down my throat. I may be completely oblivious. I’m not saying you have to do this – it’s a suggestion because I promise I don’t intentionally go out of my way to upset anyone. Be gentle with each other in a time of social isolation – we’re not getting a lot of practice interacting when we live alone or live with a limited set of people.
And with that, I’m going to wrap this personal update. Thank you for reading. Without you this would be text sent into the void of space. If you haven’t heard it today: you are loved. You are a human of value and you deserve to be here. You have something to contribute no matter what that mean voice in the back of your head says and I hope you share it with me someday.
An organization called Masks Save Lives is currently calling out a link between “low mask acceptance cultures” and how badly COVID-19 outbreaks are affecting these areas and their failures to flatten the curve once outbreaks began. Research potentially supports this division, a 2009 study in Australia found that the data could not be assessed for if cloth mask usage reduced seasonal infections in the public due to low compliance by participants.
The CDC now recommends wearing masks and numerous websites have come out with instructions on how to make a cloth one (here’s one!). However, is there something to the cultural divide? We’re going to look at the United States specifically (though the next Tweet is from the UK).
Why Do People Not Wear Masks?
Mask acceptance is not as easy as mandates and public health advisories. Beyond the scientific and home care acceptance, it must not be seen as a threat. Previously the lack of compliance in the Australian study may have been related to an element of social acceptance, however this was not studied at that time. If someone is uncomfortable wearing a mask they won’t. One community that may feel this impact are ethnic and racial minorities in the United States. One 2010 study investigated the barriers to mask wearing among urban Hispanic households in cases of upper respiratory infection. The findings concluded that these communities required higher risk perception scores before adopting face mask usage. This lead the researchers to conclude that face masks are unlikely to be effective for this community in the case of seasonal or pandemic influenza like conditions. The participants voiced concerns about social acceptability of masks within their communities – if they would be viewed as the source of illness – while others mentioned potential embarrassment.
§ 18.2-422. Prohibition of wearing of masks in certain places; exceptions.
It shall be unlawful for any person over 16 years of age to, with the intent to conceal his identity, wear any mask, hood or other device whereby a substantial portion of the face is hidden or covered so as to conceal the identity of the wearer, to be or appear in any public place, or upon any private property in this Commonwealth without first having obtained from the owner or tenant thereof consent to do so in writing. However, the provisions of this section shall not apply to persons (i) wearing traditional holiday costumes; (ii) engaged in professions, trades, employment or other activities and wearing protective masks which are deemed necessary for the physical safety of the wearer or other persons; (iii) engaged in any bona fide theatrical production or masquerade ball; or (iv) wearing a mask, hood or other device for bona fide medical reasons upon (a) the advice of a licensed physician or osteopath and carrying on his person an affidavit from the physician or osteopath specifying the medical necessity for wearing the device and the date on which the wearing of the device will no longer be necessary and providing a brief description of the device, or (b) the declaration of a disaster or state of emergency by the Governor in response to a public health emergency where the emergency declaration expressly waives this section, defines the mask appropriate for the emergency, and provides for the duration of the waiver. The violation of any provisions of this section is a Class 6 felony.
Code 1950, §§ 18.1-364, 18.1-367; 1960, c. 358; 1975, cc. 14, 15; 1986, c. 19; 2010, cc. 262, 420; 2014, c. 167.
I was unable to find documentation online of how those with disabilities that inhibit the use of masks are handling the situation or even recommendations for these individuals on how to stay safe. If you find anything, please tell me.
-If you must go outside or to a place where you are not able to practice social distancing with an infant, cover the infant carrier with a blanket, which helps protect the baby, but still gives them the ability to breathe comfortably. Do not leave the blanket on the carrier in the car or at any time when the baby and carrier are not in direct view.
-Children who are considered high-risk or severely immunocompromised are encouraged to wear an N95 mask to best protect themselves.
-Families of children at higher risk are encouraged to use a standard surgical mask if they are sick to prevent the spread of illness to others.
In terms of the minimum effectiveness and materials? An Experimental Study of Efficacy of Gauze Face Masks published in 1920 the researchers concluded that cloth masks had basic minimum requirements that had to be met in order for a mask to have a “restraining influence on the number of bacteria-laden droplets possible of inhalation”. Part of this involved a balance between the number of layers, thread count, and breathability. If the mask is too dense as a result of the layers and thread count then “breathing is difficult and leakage takes place around the edge of the mask”. That leakage of air is what they proposed caused the reductions in efficacy observed. Research such as this resulted in recommendations of a minimum of 300 thread count fabric still used today.
Cost Prohibitive / Unable to Obtain
We’ve talked about poverty before. This can impact obtaining supplies, time to make a mask, and many other life factors that are none of my business and we need to be understanding. Others are unable to sew or are unable to put a mask on for themselves (see “modifications” above).
Do Cloth Masks Really Help?
We began asking this question a long time ago. In a 1920 study on gauze masks looking retrospectively at the data from the 1918 influenza pandemic regarding the infections contracted by healthcare workers, authorities’ primary criticism was that the weave of the fabric was too loose. Though the study still concluded that masks did not demonstrate to have a degree of efficacy that would warrant their compulsory application during an epidemic, they argued that masks should not be abandoned entirely. I’ll leave it in their words:
Studies made in the Department of Morbidity Statistics of the California State Board of Health did not show any influence of the mask on the spread of influenza in those cities where it was compulsorily applied, and the Board was, therefore, compelled to adopt a policy of mask encouragement, but not of mask compulsion. Masks were made compulsory only under certain circumstances of known contact with the disease and it was left to individual communities to decide whether or not the masks should be universally worn.
The reason for this apparent failure of the mask was a subject for speculation among epidemiologists, for it had long been the belief of many of us that droplet borne infections should be easily controlled in this manner. The failure of the mask was a source of disappointment, for the first experiment in San Francisco was watched with interest with the expectation that if it proved feasible to enforce the regulation the desired result would be achieved. The reverse proved true. The masks, contrary to expectation, were worn cheerfully and universally, and also, contrary to expectation of what should follow under such circumstances, no effect on the epidemic curve was to be seen. Something was plainly wrong with our hypotheses. We felt inclined to explain the failure of the mask by faults in its application rather than by any basic error in the theory of its use. Consequently, Bulletin No. 31* of the Board of Health brought out the fact that where it was sought to control influenza by compulsory wearing of masks certain obstacles developed. These were:
First, the large number of improperly made masks that were used.
Second, faulty wearing of masks, which included the use of masks that. were too small, the covering of only the nose or only the mouth, smoking while wearing, etc.
Third, wearing masks at improper times. When applied compulsorily masks were universally worn in public, on the streets, in automobiles, etc., where they were not needed, but where arrest would follow if not worn, and they were very generally laid aside when the wearer was no longer subject to observation by the police, such as in private offices and small gatherings of all kinds. This type of gathering with the attendant social intercourse between friends, and office associates seems to afford particular facility for the transfer of the virus. If, as seems probable, the virus is droplet-borne, this form of contact, where people are conversing with one another, would, of course, be much more dangerous than crowd association of strangers, even under the circumstances of gathering in churches and theatres. We were not satisfied, however, with this seemingly perfectly satisfactory explanation. We felt it to be imperative, if the mask were not to be permanently discredited, that more definite information be obtained concerning its uses and limitations. If, as we believed, the gauze mask is useful as a protection against certain infections, it would be unfortunate if its uncontrolled application in influenza should result in prejudicing critical and scientific minds against it.
A 2011 review of “Physical interventions to interrupt or reduce the spread of respiratory viruses” found that …
Respiratory virus spread can be reduced by hygienic measures (such as handwashing), especially around younger children. Frequent handwashing can also reduce transmission from children to other household members. Implementing barriers to transmission, such as isolation, and hygienic measures (wearing masks, gloves and gowns) can be effective in containing respiratory virus epidemics or in hospital wards. The more expensive, irritating and uncomfortable N95 respirators might be superior to simple masks. It is unclear if adding virucidals or antiseptics to normal handwashing with soap is more effective. There is insufficient evidence to support screening at entry ports and social distancing as a method to reduce spread during epidemics.
…meaning that isolation, hygiene, and barriers like masks were effective.
On a lukewarm note, a 2013 study found that they were “better than nothing” against droplet transmission during an influenza pandemic.
Cloth masks resulted in significantly higher rates of infection than medical masks, and also performed worse than the control arm. The controls were HCWs who observed standard practice, which involved mask use in the majority, albeit with lower compliance than in the intervention arms. The control HCWs also used medical masks more often than cloth masks. When we analysed all mask-wearers including controls, the higher risk of cloth masks was seen for laboratory-confirmed respiratory viral infection.”
With such mixed reviews being published, why wouldn’t we be hesitant to recommend masks when they’re being advised as only a last resort?
When is a mask not a good idea?
Masks can lead to inhaling your own infectious droplets from a sinus infection and spread it to the rest of your airways.
Here’s an anecdote. I am having trouble finding papers to support this, but this is the current hypothesis my immunologist and I have as to how I got that month long pneumonia in March 2020.
I had a sinus infection and I was wearing a mask. Then, I aspirated droplets from my sinus infection leading to a lung infection. This lung infection eventually developed into a pneumonia. This is an instance of when a mask is not a good idea. Circumstances when you can aspirate your own droplets from a sinus infection or from an oral infection would be while exercising, crying, or dealing with temperature or humidity swings that would result in a runny nose.
Other people who should not wear masks? The CDC recommends against masks for anyone with breathing problems, such as shortness of breath, children under the age of 2, and “Anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.”
Wear a cloth mask if you can and assume good intent for everyone wearing a mask. They aren’t doing anything suspicious. Don’t call the police.
Masks work more than nothing. Please wear them, but wear them smartly. They do not make up for poor hygiene practices.
Some people can’t afford the supplies to make cloth masks, or they need modifications for their unique needs, or they cannot make the mask themselves. There are resources for that.
Children’s masks need consideration based on your child’s needs.
Masks are not always a good idea. Inhaling your own droplets can lead to pneumonia not related to COVID-19.
Thank you for reading this. Without you I am shouting into an ether. If you enjoy and want me to write more of these please share this or comment below with what you would like to see me write next.
I started writing this article on 8 April, 2020 and stopped because I needed a break from writing about coronavirus related topics.I will be continuing to update this post-publication.
Remember how we were projected to have 2.5 Million cases? We have reduced the projected number of infected Americans by 1.5 Million to only 1 Million. 1 Million is not great, but that’s a big change. That is called flattening the curve and everyone should be thinking that is really amazing (I know I am). They did not mention the number in the briefing (frustratingly). But forecasting has gotten a bad rep in the past.
For those who are math nerds – that’s a linear fit to 1,000,000 (switch from exponential), which some dude in the early 20th century proposed was when the growth in the number of reported influenza cases was hitting it’s predictable rounded peak forecasted the maximum cumulative cases (the limit). I’ve been trying to go through my notes to remember more about how this all works because I don’t remember the name of who came up with all of this and I’m trying to find the paper. I will update this and replace this rambling text when I do.
A vaccine would be able to address this by using adjuvants designed to induce helper T cell immunity in addition to antibody based immunity. Vaccines take time. Realistically a good vaccine will be on the market in March 2021 at the absolute earliest. Anything before that I will be floored if it has sufficient efficacy to help.
At each of these state clusters there is at least one urban center that has the dominant reservoir population. Once movement between urban centers (New York -> Chicago -> Houston -> Miami -> Atlanta -> Boston -> Dallas -> L.A. -> San Francisco -> Chicago -> Orlando -> Pittsburgh -> (etc. etc. etc.)) stops then there will no longer be additions of infected individuals into the populations. This is why non-essential planes need to be grounded.
I live in Montana. I am so blessed. I want to make it clear that we still need to behave. It only takes 1 person to infect 10.
My family and people I love live in Washington, Idaho, Oregon, Montana, California, Texas, Alabama, Louisiana, Florida, Virginia, New York, New Jersey, Massachusetts, New Mexico, Arizona and Maine. I’m terrified for everyone.
We’re going to gradually come to a new normal. Ask me questions and I’ll eventually address them in updates on these original posts.
As a change of pace, I’m going to stop writing about the coronavirus for a while unless there’s something people specifically think of graphs or other things that would be useful questions to be answered in something new instead of an update. I still have a backlog of a couple posts that will still get done though.
I will be starting to write short stories and weird little memoir style posts so people can enjoy my writing separate from the reviews.
Thank you for reading. Without you this is a shout into the void.
The start of April 2020 has been hard for the United States.
Forecasting Cumulative Case Totals
It is really cool to watch the things start to flatten. But is that flattening from New York City? Unlikely. As of 5 April 2020, we pushed the 500,000 milestone out to 6-7 of April from what was predicted to be 1 April 2020 based on the early spread. Most likely it’s being contained and squashed in small communities via quarantines successfully and that is preventing the further spread at this time. In 1918, this drive to reopen cities and lift restrictions resulted in second outbreaks in many cities.
Let coronavirus be eradicated from your small town.
Update 5 April 2020:
I’m going to start breaking down the specifics for each state to develop forecasting. It sounds like coronavirus is going to be with us for a long time, so we might as well figure out a way to predict these ebbs and flows that accounts for human behavior as well. Part of each post will be a regular update showing how the forecast is changing. By seeing that our actions have impact maybe I can provide a bit of positive feedback for people that need encouragement.
If coronavirus is with us, that means it has found its reservoir population. This is bad. This means it hangs out in those people and does nothing except infect others until their body maybe figures out something is going on. West Nile Virus and Dengue Fever hang out in mosquitoes this way, kind of. It’s more complicated than that. This sounds like another post.
Social Distancing Score
I don’t agree with all of their measures and I will explain why I think they are only accurate in certain parts of the country in another post. That said, I do think that it is a useful tool for awareness and contemplation on the score.
As of 5 April 2020 the United States is still struggling with the concept of social distancing and these example struggles are leading to serious consequences. Do I think the above scoring system makes sense? No. But it’s better than nothing and I will address each state individually over the coming weeks while updating the rest of these.
We’re watching the curve flatten nationally, but I hypothesize that this is actually the accumulated effect of rural areas and low exposure areas quarantining and eradicating COVID-19, not New York City.
In 1918, this drive to reopen cities and lift restrictions resulted in second outbreaks in many cities. Let coronavirus be eradicated from your home town before we reopen everything.
Social distancing is hard to measure and important to be aware of. I will discuss this more.
New York City is a visible hot spot and may have an undiagnosed reservoir population that is asymptomatic or minimally symptomatic. We need accurate testing.
Thank you to anyone reading this. These are shouts into a void without you.
The New Jersey Health Department is carefully tracking cases (image below). The majority of deaths and cases have been in the New York City metropolitan area. Cases have shown need for medical intervention – see below.
What Is Preventing The Curve From Flattening?
Factors Unique to New Jersey
New Jersey is a special state. From the Jersey Shore through Hoboken to the rural borders with Pennsylvania and the beautiful southern parks and rural areas along the Atlantic Ocean and bay – New Jersey is a unique state that saw no action during the Civil War, and is filled with a unique mix of immigrant heritage through history. This mix shares deep rooted values in family, multigenerational gatherings, faith, and the importance of extended family as caregivers, making New Jersey vulnerable to coronavirus.
The C in decrease in average distance traveled is not surprising with a rural population in the state. As I do analyses on state like Arizona and Montana I will argue against that measure because in Montana we’ve been doing social distancing since before it was cool, but we have to drive 5 hours to get anywhere.
Overall, New Jersey, keep up with the social distancing and work on the Philadelphia side of things hopefully.
New Jersey and 1918
In 1918 the Influenza Pandemic spread out from Philadelphia to New York City, not from New York City to Philadelphia. Due to this lack of congruency and the increase in connectedness of both cities via mass transit, it is more likely that New Jersey will see 1-2 peaks entirely dependent on those of New York City and Philadelphia. The visibility of that separation is entirely dependent on the state of New Jersey flattening the curve between those two outbreaks.
Is New Jersey Really Showing No Signs of Slowing?
I decided to break this down into 2 milestones: 100 cases and 1000 cases. I then compared the growth in cumulative cases to present from each.
Based on the growth of cumulative cases since the 100th case, New Jersey has had 2 changes in their cumulative growth since their 100th case (I round up due to reporting error). On 20th March 2020 and 26th March 2020 something happened. Given that SARS-CoV-2 has an incubation period of up to 2 weeks, what events could have caused these surges?
Based on the model above, New Jersey is predicted to reach 100,000 cases as of the 12th of April, 2020. This does not take into account the backlog of tests nor daily processing capabilities of labs for these tests.
If we look at just the cumulative cases since the 1000th case, the 100,000th case is predicted closer to 15th of April, 2020. This does indicate curve flattening because this milestone is being pushed out.
This means that the citizens of New Jersey are acting as vectors of disease to the Philadelphia and New York City areas (or anywhere else they are traveling). But there’s a reason patients are seeking help elsewhere.
In 100 years we gained the ability to monitor the disease, albeit imperfectly, and make predictions. Disease forecasting based on mathematical predictions was used primarily in agriculture when I was in school. With agriculture, we use satellite imagery to look for indications of disease by looking at light reflection/absorption patterns. Crazy right?
No. New Jersey will likely have 1 – 2 peaks – one shared across New York City and Philadelphia. The separation between these two peaks will depend on social distancing, hygiene practices, and the adoption of publicly wearing masks. We can examine milestones and projections for changes overtime to try and guess when these will be – if we reach a peak before Philadelphia has reached its peak, then yes, there will be a second peak for New Jersey. Milestones can be used in the process of forecasting for making quick decisions.
The slope is changing. If we look at only the last few days, we have moved farther out how long it takes to reach that 100,000th cumulative case milestone to the 14-15th of April 2020. The acts of individuals allows us to flatten this curve more.
With the actions of every day people, such as social distancing, staying at home, adopting public mask wearing, and hygiene awareness, we can flatten the curve.
If you currently live in New Jersey, I love you, please stay safe, and isolate if you can.
New Jersey’s Peak is Following New York. If the curve does not flatten more, we could hit 100,000 cases by around 14-15th of April 2020 unless things improve.
At this time it does not look like New Jersey is hitting a peak. New Jersey is kind of flattening the curve. There will be 1-2 peaks dependent on New Jersey’s ability to flatten the curve in between New York and Philadelphia’s peaks.
To help flatten the curve: practice social distancing, stay at home, adopt public mask wearing, and remember hygiene awareness. We can flatten the curve. Flattening the curve now will hopefully protect New Jersey when Philadelphia peaks later.
People are still sick with heart disease, cancer, bacterial infections, influenza, autoimmune disorders, tumors, and everything else under the sun and because the medical system is overwhelmed, those people aren’t getting sufficient care.
Thank you to anyone that reads this. Without you I’m just shouting into a void.