I don’t want to share a picture of my ankle, so here’s one of Nyxie’s recent gifts to us. We gave it back, but she is so sweet. She’s my kitten.
One of the things I learned at my appointment at UCSF was that the failure for my right Achilles tendon to respond to one if the normal reflex triggers is because the tendon ruptured. I’ve been walking on a ruptured Achilles tendon for over a year. An injury I shouldn’t be able to walk on because for most people it should be too painful. I’ve been walking on it normally for over a year.
Having very high tolerance to pain is a strange thing. It’s not that I don’t feel the injury. My brain compartmentalizes sensations – tells me what can and can’t be extreme, therefore I shouldn’t worry about it. That funny feeling in my ankle? Well, it got a little red, but it never got super swollen. It never got “yo, your tendon is torn and needs to be surgically repaired, so stop using it.” I figured I was getting repeat minor sprains in my ankle.
But I’m not alone. Others have reported not feeling pain associated with the injury, even with full ruptures that render the ankle more severely damaged than mine. Professional athletes have made winning plays with this injury, completely unawares.
It explains why I kept rolling my ankle unintentionally and strengthening exercises weren’t helping to prevent it from happening on that side. My father is known for having the same kind of pain tolerance.
The same doctor that discovered this performed my lumbar puncture for my CSF analysis and donation. Even though I have high pain tolerance, it took longer than expected and more lidocaine than expected to numb the area for needle insertion between L3/4 (or was it L4/5?). Given I am also known for waking up during surgeries and remembering everything, I’m not bothered by it.
So I now have an acute awareness of having ruptured my right Achilles’ tendon in June 2019 and I’ve been walking on it this whole time. The pain has started to creep into the functional peripheries of my day from what was once just a “kind of weird off feeling.”
The more I walk on it, the more I realize that by the end of every day I can’t walk on it. I’ve been doing barre, running, going to the gym, climbing, hiking, gardening, carrying small children, and so much more while punishing myself for not being able to do more. For some reason I unconsciously convinced myself my ankle injury was “all in my head.”
That’s the update. My ankle hurts now – that level of awareness hit last night like a loony tunes piano and now I’m staying off of it. Doctor appointment over the phone on Monday to discuss. It doesn’t hurt if I don’t walk on it, so I’m not walking on it.
Sorry for the boring update. Stay tuned. Next week Jacob and I plan to release a series of joint posts we’ll be writing together and scheduling this weekend. One of which is a 2020 review of The Matrix. My 1917 Kodak camera finally arrived and can confirm that the lenses are fully intact for that upcoming post. The other is a detailed discussion of long haul road tripping in an electric car while socially isolating and trying not to get covid using the United States charging network. The posts I’m looking forward to most actually involve videos and write ups on The Radiator and Jacob introducing some exciting news around our adventures in lasers.
I’m not hyperlinking because the above is a teaser for those that made it through me bitching about my ankle.
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 did say rainbows
Beautiful Montana
These are all from today
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
You’d never believe this is one of the major shipping routes across the US border into British Columbia, now would you?
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.
So helpful
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.
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.
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.
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.
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.
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.”
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.
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.
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.
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.
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.
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.
