June 2013 – A Poem

2012 Sespe Condor Sanctuary

I didn’t want to pick out an appropriate picture for this poem. I picked out something calm that reminded me of the opposite of what this day felt like. Many of my poems are flashbulb memories or combinations of flashbulb memories. This poem is the worst day of work I have ever experienced. I don’t know if, in a literary sense, this poem is any good. There are quite a few poems like this I keep hidden: more personal in nature and harder to predict how a reader is going to react. Let me know what you think in the comments or like it. If you do like this poem, share it with your friends so I can get a decent survey of whether or not to post more like it.


June 2013

I watch a woman melt today
Skin sags off a decomposing body
With a sputtering heart
Interstitial fluid melts into
The heated inflated bed
Brain death at 4 o’clock in the afternoon
Her children bicker in the hallway
Her pacemaker trips
Every few minutes

They sign away their rights to sue
Hospital-Acquired Infection List Marathon
As the ventilator sings positive pressure
”So she never woke up from the surgery?”
”No, ” the doctor lies
Through his military smile

I am a phlebotomist and
A disease controller:
Biohazard level 4 room, Sir
Check-in Check-out – a list procedure
[Can’t talk back to the M.D. – Report her!]

I keep my mouth shut
As they beg for hope
Their mother’s dripping on the floor
More Chux! More Chux!
But their sister has to get there
Before they allow us
To turn off the machines.

New Jersey: Are We Flattening The Curve?

New Jersey Surge Approximately 1 Week Behind New York

As of 4 April 2020 more citizens of New Jersey have died of SARS-CoV-2 than died in the 9/11/2001 attacks.

The eastern part of the state of New Jersey abuts New York City, whereas the western part abuts Philadelphia. If we assume that New York City is the reservoir – or major source of infections that spread out into surrounding areas – New Jersey sits between New York City and Philadelphia. They’re shielding in some regards. New Jersey is predicted to be 1 week behind New York’s recent infection surge. Philadelphia may follow, with Pittsburgh 2 weeks after that based on the 1918 model.

Source: https://coronavirus.1point3acres.com/en

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

Source: https://www.nj.com/coronavirus/2020/04/these-charts-and-map-show-how-coronavirus-pandemic-is-spreading-across-nj-saturday-april-4-2020.html Play with this one – it’s interactive!

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.

Places of Worship

I get that we need to think about Easter. Stay home if you can. All places of worship are closed in the state of New Jersey.

Social Distancing

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

Parts of the state of New Jersey are taking social distancing very seriously. Parts, surprisingly close to Philadelphia, are not. The tourist areas of New Jersey are taking social distancing more seriously, and have issued advisories urging those with vacation homes not to come.

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

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.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing – We can see that there are changes going on. Do you like the new style of graph? Tell me in the comments. I can go back and update other posts.

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?

20th March 2020 was when New Jersey ordered limitations on business operations. And look at how that curve flattened. It’s almost as if there was a huge testing backlog. If we look 2 weeks prior to that, New Jersey only had 4 reported cases of coronavirus on 6 March 2020. More likely social distancing behaviors began when the first cases were being diagnosed on 6 March and it requires a full two weeks to see the impact of this change in behavior. On 26th March 2020 NJ.com reported that as of that day the number of SARS-CoV-2 cases of unknown origin outnumbered those of known origin in every county of New Jersey. It is more likely that the change in the graph is associated with the state ordered limitations.

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.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit#gid=245520383

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.

Healthcare Systems Overwhelmed

Patients from New Jersey are heading to Philadelphia and New York hospitals for treatment in addition to those in New Jersey. New Jersey’s healthcare resources:

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.

According to NJ.com, “State Health Commissioner Judith Persichilli said 12% of all hospitalizations in the state are now due to COVID-19. Of those, 41% require ventilators to stay alive.”

That said, centers specializing in pediatric covid-19 patients are becoming available. There are at least 144 pediatric patients in the state at this time.

To help prevent the spread of coronavirus, rules are being implemented in maternity wards that ban expectant partners from being present during the birth. This is in line with the rules adopted across the country banning visitors.

Milestone Forecasting

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?

I discussed forecasting in the post about New York. Ask questions and I can go into the mathematics of these models more.

Are we at the peak yet?

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.

TL;DR

  • 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.

Pennsylvania: Are We Flattening The Curve?

Pennsylvania Department of Health Declares There is “No Sign of Slowing”

As of 12:01 AM 4 April 2020 Pennsylvania exceeded the 10,000 case milestone.

The majority of cases in Pennsylvania are in the Philadelphia and Eastern Pennsylvania region along the Boston-Washington commuter corridor. As this is a major thoroughfare connected to New York, Connecticut, and New Jersey, and transit systems only recently began reducing service along this route, this is not a surprise.

source: https://theburgnews.com/news/positive-covid-19-cases-exceed-10000-in-pennsylvania-almost-1600-new-cases-today

The Pennsylvania Health Department released the following statistics on positive SARS-CoV-2 cases within the state:

  • Nearly 1 percent are aged 0-4
  • Nearly 1 percent are aged 5-12
  • 1 percent are aged 13-18
  • Nearly 8 percent are aged 19-24
  • 41 percent are aged 25-49
  • Nearly 29 percent are aged 50-64
  • Nearly 20 percent are aged 65 or older.

There have been no pediatric deaths, unlike Illinois.

What Is Preventing The Curve From Flattening?

Philadelphia vs. Pittsburgh

A few factors are unique to Pennsylvania, one such being the presence of a large religious population known for participating in religious exemption. In the broader southeastern corner of the state, outside of Philadelphia (the eastern bottom edge of the state) these populations live beautiful lives.

In the western part of the state, an additional area is being hit – Allegheny County, home of Pittsburgh. Pittsburgh has its own unique culture. It is a very social city where strangers talk to each other and it is not hard to make friends if you want to go out. Social distancing presents a challenge here. We also run into the poverty and rural hospital problem in western and central Pennsylvania.

Places of Worship

At this time places of worship in Pennsylvania are continuing to operate. Recently, places of worship are coming under scrutiny as major sources of coronavirus infection. I will be addressing this more in another post.

Adoption of Social Distancing

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

Unacast has rated Pennsylvania as a C- based on two factors.

Source: https://www.unacast.com/covid19/social-distancing-scoreboard 25-40% Decrease in Average Distance Traveled Per Person; 60-65% Decrease in Non-Essential Travel To Non-Home Location

The majority of trouble is in small towns in rural areas. This is not surprising, but it is important to those that we need to behave as though coronavirus is spreading through an asymptomatic or minimally symptomatic reservoir host. This means that all it takes is one person in town and the whole town could get COVID-19 very quickly.

Pittsburgh and Delayed Outbreak

In 1918, Pittsburgh’s influenza outbreak was a full 3 weeks behind that of Philadelphia’s. Pennsylvania was one of the hardest hit states during 1918, and Allegheny County was no exception. Let’s remember how even within the past 10 years, new, previously unknown mass graves from 1918 are still being found throughout the state, and particularly in western Pennsylvania [1, 2, 3].

Is Pennsylvania 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.

source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

Based on the growth of cumulative cases since the 100th case, Pennsylvania is predicted to reach 100,000 cases as of 14th of April, 2020.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

If we look at just the cumulative cases since the 1000th case, the 100,000th case is predicted closer to 12th of April, 2020.

So, yes, the health department is 100% correct. Pennsylvania is showing no signs of slowing.

Healthcare Systems Overwhelmed

The healthcare system in Philadelphia is overwhelmed, but not for the initial reasons one might think. Out of state patients from New Jersey and New York are heading to Philadelphia hospitals for treatment. This does reduce the resources available for those living in the local area. This also introduces additional vectors of disease to the Philadelphia area.

To better address the growing need to hospitals, cities are attempting to reopen those that have closed, particularly in poorer areas. There is an empty hospital in Philadelphia that the city is attempting to reopen. One massive barrier is that the building is privately owned by a California investment banker. This is only one hurdle.

Large hospital networks across the country are shifting spending while furloughing employees in preparation for outbreaks, including patient care workers. This is also occurring in Philadelphia. The argument for reducing staff is one of finances and the increased costs of each coronavirus patient amid bidding wars for supplies. These privately owned large hospital networks operate in multiple states, resulting in the shifting of resources affecting those where the outbreaks will eventually hit next.

Milestone Forecasting

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?

I discussed forecasting in the post about New York. Please ask questions and I can go into the mathematics of these models more.

Are we at the peak yet?

No. Pennsylvania will likely have 2 peaks – one for each major city. We can examine milestones and projections for changes overtime to try and guess when these will be. Milestones can be used in the process of forecasting for making quick decisions.

At this time Pennsylvania is projected to hit its 100,000th case on 14th of April 2020. That said – this is a graph based on many data points that can be broken up.

There’s a lot of hope in that graph shape if you think about how much impact the actions of individuals can have. The slope can change and extend out that milestone if everyone starts taking this seriously. If we look at only the last few days, we have moved closer how long it takes to reach that 100,000 cumulative case milestone to the 12th of April 2020.

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.

This post is dedicated to my friends currently in Pittsburgh, Pennsylvania. I love you. Please stay safe. I owe all of you hugs the next time I see you.

TL;DR

  • Pennsylvania is not flattening the curve. If the curve does not flatten more, we could hit 100,000 cases by around 12th of April 2020 unless things improve.
  • At this time it does not look like Pennsylvania is hitting a peak. There will likely be 2 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 Pittsburgh 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.

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.