Publication Announcement: Waking Up – Part 5

Deidre faces her mother in Waking Up – Part 5.

To read parts 1-4, visit my author page here.

**Content Warning:** This story contains depictions of and allusions to the abuse of vulnerable populations, such as those with disabilities, LGBTQA+, and children of abusive parents, and may contain content that some may find disturbing. Reader discretion is advised.

Remember where your happy place is!

Things In Writing I Pay Attention To That Other People Might Not Care About

If Haskell gets any closer Nyxie will show him the consequences

Yes A Does Really Have To Get To B Eventually

Cause And Effect

Every action has an equal and opposite reaction. Unresolved situations are frustrating.

Example: If a character experiences trauma, they will be traumatized and then display signs of trauma as a result of the event.

To not experience trauma in response to a traumatic event indicates something other. This could be used as a literary device. If it is not being used as a device it is distracting and takes away from the work. Make sure all actions have consequences.

Does The Characterization Of Each Character Match Up With The Timeline?

Characters are on a journey. Each character is moving from A to B and some will go on to C or D. Along those paths each character is changed. This creates the timeline of a book. How a character is portrayed in a scene needs to match the point in the timeline a character is at.

Example: A character that is in her twenties thinks about bills and her job as opposed to a character in her teens that is thinking about school. Because of this, the relationships formed around these areas are most important in life and are the most emotionally impactful outside of family and those that might as well be family.

We Didn’t Go Anywhere

When the setting of a story changes it’s important to have some form of transition to show movement of time and place.

There are some stories that don’t include enough details about objective indicators of passage of time and check that they are consistent such that all of the details of the story align temporally.

There are some stories that don’t include them at all and it’s somehow eternal summer somewhere bizarre like Alaska.

There are some stories that include way too much detail. It’s overwhelming and distracting from the story. I am suddenly studying the passage of time and the changing of the seasons instead of the nature of man.

There are some stories that include lots and lots of details. So many details. All the details. But none of them align temporally, so suddenly April was both 6 months ago and 2 months ago with Winter only 3 months away. This is when I start getting headaches. James Joyce does this. A lot.

Characters Have Hidden Lives

It’s Okay To Have “Offensive” Characters

There’s a huge difference between an “offensive” character that upsets readers and an overdone inaccurate stereotyped character that upsets readers because it doesn’t resonate.

The best offensive characters speak to the group they’re offending because they are too accurate and too real. This will be upsetting to some people. That’s the kind of “offensive” I relish. There may be those that demand a content warning. Good – research is showing that content warnings increase the reads a piece gets much like good tagging because people are seeking them out.

I don’t care who the author is – I promise if you have done your research and shaped your character in a way that reveals truths in your observations, I will love your character even if people get really upset with you over it. Cut the wound deep and hit where it hurts, not where it’s been done ad nauseum unless it’s real. Reveal something no one else has, but remember that pen names exist for your protection.

Your Characters Have Conversations The Reader Doesn’t Know About And Doesn’t See

An author cannot document everything. They are writing down a snapshot of a potential alternate universe that could exist because someone thought of it, right? That means all of those characters have private inner lives the reader can’t possibly know in its entirety. This means characters can have relationships with each other that are implied instead of explicitly stated. All of this helps to create depth.

It helps to come up with a full backstory for every character in a story even if it’s never talked about or mentioned. This will influence how dialogue is written and how hidden relationships between characters are revealed.

Your Characters Have Moods

Depending on your character’s internal state they will have a mood. This mood will translate into action or inaction in response to a stimulus and that will result in some consequence. Moods and energy levels related to exhaustion as an effect of the story timeline should all be cohesive.

Your Characters Of Different Cultures Are Going To Have Trouble Getting Along

Culture clash is real. The minority of people will be peaceful and fine and that’s great, but your characters aren’t the saints you think they are. Nope. They are averse to change and other cultures and view other as dangerous. This goes all ways. Be real – your characters from different cultures are going to be uneasy around each other and hesitant to make friends for legitimate reasons evolutionary wired in (if they’re humanoid).

Settings Are Places That Can Only Be Known Through Experience

Setting Descriptions Have A Time And Place With Characters In Them

It is not uncommon that I run into setting descriptions that are detached from the story either by the characters not interacting with the setting features or by the characters existing completely separate from setting descriptions.

By integrating setting details with the story as a whole the sensory experience can be the focus. The integrated sensory experience of the setting provides the reader with a greater sense of passage of time.

Settings Indicate Culture

Think about it – In the United States, if I set a story in the South a reader is going to anticipate a lot of passive aggressive saccharine manipulation straddled by y’alls happening. If I set a story in the Northeast, there’s a more WASPy social norm puppet show expectation.

But that’s based on the dominant culture of an area. What about when you’re writing about an area’s subculture?

I like to refer to framing subculture structures in writing as “country clubs” – it’s exclusive, you need to know someone to be someone, and there are generally specific central gathering places.

TL;DR

  • Make sure everything makes sense temporally
  • Ground the reader in temporal details outside the character
  • Offend by speaking the truth and make very effort to ensure that truth resonates in an effective and impactful way with the audience
  • Characters have conversations the reader won’t see but totally influence what the final dialogue will be.
  • Characters have inner lives, states, and energy levels that change as a result of the story. Write that.
  • Culture clash is real. Observe it and describe it. Be curious and nuanced. This gives a story so much depth.
  • Details of setting can be added to show passage of time in the story and immerse the characters and action in the location.
  • Settings indicate dominant culture and can somewhat indicate subcultures.

Thank you for reading! If you like this post on writing please like and let me know. What are things in books that drive you crazy?

Aversion to Masks? How Masks Make A Difference

Why Wear a Mask?

Source: https://www.maskssavelives.org/

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).

An example of the reaction someone gets going to the store wearing a mask in England – one of the countries accused of having an anti-mask culture by the organization.

Why Do People Not Wear Masks?

Social Acceptance

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.

Many have long dealt with violence related to the use of masks. Assumptions related to suspicion of crime, gang activity, and other racial profiling can making wearing a mask uncomfortable.

Legality

In the state of Virginia it is illegal to wear masks in public, though after the CDC’s announcement the law no longer applies.

§ 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. 262420; 2014, c. 167.

Modifications Needed

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.

In other cases we need to consider family caregivers, and children, both needing modifications and not. Many children struggle to wear masks, particularly infants and toddlers. The primary reason most experts encourage children to wear masks is to prevent them from giving it to others, rather than to prevent them from contracting the virus themselves. But the CDC still insists that all children over the age of 2 should be wearing a mask when they leave the house. I am looking for further resources – at this time I have heard about this problem from friends that are parents.

The American Academy of Pediatrics has released the following guidelines for masks and children with special health considerations:

-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.  

source: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/masks-and-children-during-covid-19/

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.

The American Journal Of Public Health.

A 2008 Study that came out in PLoS One found that wearing homemade cloth masks reduced hypothetical infections after spraying people with a simulated contagion.

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.

Health Belief Models are one of the most mad scientist or the most Psy Ops things about public health. How do you get an entire population to do participate in something that will help be better for everyone else in the long run – like washing hands? In 2014, a literature review of cloth mask usage was published in the Singapore Medical Journal taking a different approach to the use of cloth masks in the context of a Health Belief Model.

A later 2015 study in BMJ Open found

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.”

TL;DR

  • 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.

How Behaviors Impact Coronavirus Spread & Confirmed Case Reporting

Part 1 – Introduction to Issues

This is a pretty loaded topic. Breaking this one up into several parts. In this post I’m addressing limitations to medical accessibility, such as uninsured rates, caregiving, and religious exemption from government advised or required disease control practices, such as social distancing. Let’s talk about human behavior and how that may impact the vulnerability of your location in the United States to coronavirus.

Accessibility, Uninsured Rates, and Alternative Medicine

Source: https://www.census.gov/data-tools/demo/sahie/#/?s_searchtype=s&s_agecat=1&s_statefips= You can play with this viewer too! Go play with census data and learn about the United States.

There are many reasons Americans are uninsured. Being uninsured will ultimately lead to limited access to healthcare. Due to decisions that were made regarding how to implement mandated healthcare, the poor were punished for not being able to afford exorbitantly priced healthcare. I don’t care who you blame for it not working. Point is, it didn’t, and now we’re sunk. You may notice a similarity between the map above and the maps in my previous post on the closure of rural hospitals and poverty. Texas and Oklahoma are currently set up to be the two of the hardest hit states by coronavirus because these are uninsured populations that feel they cannot seek already-limited healthcare (because hospitals closed). This means that they turn to alternative medicine at home and don’t call a doctor due to the cost. Alternative medicine, though potentially complementary (waiting on research), doesn’t involve providing ventilators to people drowning from their own viral lung inflammation. Alternative medicine doesn’t necessarily involve reporting confirmed cases to the state, either.

Luckily, telemedicine is slowly stepping up the game at reducing costs and improving accessibility, but until we have Point of Care testing that allows for mass screening that could be distributed to a population via the health department – good luck. The FDA still strictly prohibits self administered tests. This is one of the major outstanding limitations preventing telemedicine from serving our most underserved and vulnerable populations in the United States during this pandemic.

Religious Exemption

Source: http://childrenshealthcare.org/?page_id=24

Religious exemptions for medical care are a real thing. I know there are people reading this that are going to think, “but no one in their right mind is thinking that now!”

Oh honey, I wish I could say that was so. Let me first introduce you to What’s The Harm. Even without coronavirus, people are and will be dying due to lack of access to medical care in part because their families opt out via religious exemptions. When this is combined with alternative methods gone wrong and cultural factors, the vulnerability of this population is amplified by pre-existing public health issues.

Part of the states’ Stay At Home orders have meant the discontinuation of standard church gatherings and not everyone is taking it so well. Across the United States, churches are challenging these orders by stating that they are restricting freedom of religion. The continued in-person gatherings of worship services and other church functions result in COVID-19 outbreaks within communities. The Palmer Grove Baptist Church in Burke County, Georgia is one example from today, 31 March 2020. Another example: a choir practice when there were no positive cases reported in the county lead to an outbreak due to asymptomatic transmission. In Arkansas, California, Florida, Louisiana, Oklahoma, South Carolina, Tennessee, Texas, Washington, and Wisconsin, churches have risked or spread COVID-19 to members through gatherings or other church related events. As long as church closures are seen as a threat, these communities will be at higher risk for impacts from COVID-19.

I’ll be making a separate post dedicated to addressing the religious exemption issue in a culturally sensitive manner. Stay tuned for part 3.

Home Care For The Sick

One of the most wonderful things about America is that we are a country of caregivers. By acting as a caregivers we enter others’ homes or share homes with them to ensure their wellbeing. Remember that map from this other post on poverty and rural hospital closures?

When we care for the sick at home, a variety of other factors come into play that may delay or prevent access to medical intervention or reporting. Cultural norms around illness, including distrust of the medical system, preference for home care, and family caregiving will play their roles in the spread of COVID-19.

Source: https://www.cdc.gov/aging/caregiving/caregiver-brief.html

This means that children and older family members that do have symptoms may not have access to medical intervention, documentation, advice, or have sufficient care or separation from family members. While these deep-rooted beliefs come from a nurturing and caring place of love, it is important that cases at least be documented. These practices currently put families and communities at high risk of having the virus spread within them. While we do have recommendations for caregivers and home care instructions for coronavirus patients, they are not practical options, nor sufficient for the average family in America.

Home Burials

Source: https://www.romemonuments.com/home-burials – great website. Highly recommend reading more there!

In Part 2 – Home Burials and Funeral Industry

Thank you to anyone reading these commentaries and predictions. Without you I would be shouting into a void.