Today I turn 31 in the year 2020. The world is chaotic (to say the least). But there is so much for which to be thankful. We have an opportunity in this dark time: we can use this as a pathway to finding our similarities and common ground. We can use this as an opportunity to show compassion toward our fellow human beings. Don’t believe me? I have a challenge for every person reading this.
If you’re ever feeling alone, think about the population of the country where you live. I currently live in the United States – a country with a population of 328.2 Million people. Approximately 27% of Americans report using Google as their primary search engine. That means approximately 88.614 Million Americans use Google as their primary search engine.
That means that whatever the statistically most likely predicted completion of a search phrase is results from millions of people searching that phrase.
This means you are not alone. With every crazy question you have for the internet, you are not alone. For these first fifteen, I’m going to be very general. Then, once this concept has been demonstrated, let’s go on a journey. Some of these are funny, some are depressing, some are revealing.
1. “Is it…”
2. “What to…”
3. “Does the…”
4. “Are there…”
5. “Do I…”
6. “Why is…”
7. “Who was…”
8. “Did I…”
9. “Where are…”
10. “Am I…”
11. “How to make…”
12. “When will…”
13. “Does the United States…”
14. “How many…”
15. “How often…”
That’s a doozy.
Okay! So 15 questions in and you’ve noticed that Americans are just as confused about our units of measure as the rest of the world and things do seem to be interesting. Plus, if you’ve been sedentary and are questioning while your bowel habits have changed, you’re not alone. Drink more water, eat more fiber, and start going for more walks. You’ll feel better.
These next questions are for those of us that recognize that search histories get a little weird when you’re writing. So, let’s start looking at some of the autocompleted questions related to writing research I’ve seen lately. These get a bit dark and others are truly revealing.
1. “What do serial killers…”
2. “Why do serial killers…”
3. “Why do wives…”
4. “Why do husbands…”
5. “Why do partners…”
6. “Do cows…”
7. “How to fake…”
8. “How to destroy…”
9. “Why doesn’t…”
10. “Humans are…”
I warned all of you that was going to get dark.
There’s one final search I am going to show you – it leads to one of my favorite poems I had forgotten about and hadn’t read in over 10 years.
“Hope” is the thing with feathers (314) – Emily Dickinson
“Hope” is the thing with feathers – That perches in the soul – And sings the tune without the words – And never stops – at all –
And sweetest – in the Gale – is heard – And sore must be the storm – That could abash the little Bird That kept so many warm –
I’ve heard it in the chillest land – And on the strangest Sea – Yet – never – in Extremity, It asked a crumb – of me.
I hope you can hear Hope’s song, and even if you can’t right now, know that you are not alone in searching for it amongst the noise.
What were your autocomplete results like when you searched similar beginning terms? Were they the same as mine? If you have suggestions of other terms for me to search please leave them in a comment 🙂
I am so thankful for your company on this bizarre journey through search engine autocompletes on my birthday. If you enjoyed this post, please share it, like, or comment. Without you, this post would be stored quietly on a server somewhere. Have a wonderful weekend ahead 🙂 With Love – Lo.
**Content Warning: This post discusses the killing and mutilation of animals by unknown perpetrator(s) over the past 50+ years in the United States. As a non-beef eater myself, reader discretion is advised**
While the world is caught up with everything that is 2020 (do you have your apocalypse bingo card yet?) I’d like to visit an ongoing state and national news story that captured my attention when I first moved to Montana in 2013. In October, 2019, new developments arose. I think it’s time to share this news with readers for the purpose of distraction. So, I’ll compile some basic information here. While I have some thoughts on what the possible explanations could be, I will save those for the end.
On October 2, 2019 the Billings Gazette reported a new report of 5 dead cattle being found in Salem, Oregon. While tragic, the random death of cattle in the Pacific Northwest would not turn heads under normal circumstances. These were not normal circumstances. Instead, this was the newest report in an ongoing series of documented cow mutilations throughout the Midwest and Pacific Northwest, with the majority of documented cases in Montana, dating back to the 1970s.
According to the original newspaper clipping from the Billings Gazette on October 10, 1975 (shown above) about 175 reports of mutilations were gathered from Texas, Oklahoma, Kansas, Colorado, Nebraska, North Dakota, South Dakota, Wyoming, Nevada, Utah, and Idaho in addition to Montana at that time. At that time, given the cost of the equipment necessary to cause the types of mutilations and damages found, the issue stumped authorities, leading to the concern of a cult traveling throughout the country traveling “by helicopter”. Reasonably so, this was thought to be ridiculous.
There is a Wikipedia page on Cattle Mutilation as a general concept, but it is important to note that this page includes international and domestic horse, goat, and other unidentified livestock incidents. These non-bovine and international incidents have mutilation patterns not matching those specifically found in the mutilated cattle of the Midwest and Pacific Northwest. That said, they may still be worth discussing for contrasting purposes.
The common pattern with these mutilations is that the sex organs and tongues are removed with all blood drained from the corpse. An investigative report mentioned in a 2001 article in the New York Times mentioned that a group that researches these incidents, The National Institute for Discovery Science, did find one interesting variation in a case in Utah where there was a hole in the head of one of the cattle with both BHT and Formaldehyde present, indicating that an embalming/preservation process took place. This group is/was funded by Robert Bigelow – a man that became obsessed with aliens and the Skinwalker Ranch – a place so notorious even the History Channel has added it to their questionable line up.
As their website is now defunct and it is hard to find information on anything other than his alien focused ventures, I am not going to spend much time focusing on this aspect for now.
Another common element between all of these cases? They remain unsolved. To give readers an idea of how extensive and compelling these reports are, there is an open case file with the Federal Bureau of Investigation regarding the recurring ritualistic serial mutilation of cattle. At this time, the FBI only investigates mutilations that occur on tribal land and all have been closed unsolved according to the Billings Gazette.
Private and public reward monies for information regarding cattle mutilations continue to accumulate, including a $25,000 reward for the recent mutilation in Oregon.
My Interest And Thoughts On These Events
Shortly before moving to Montana, on March 1, 2013, a rancher found more mutilated cows approximately 5 miles outside of Browning. Given how current it was in the news, this provided the opportunity for me to learn more about these incidents and start compiling information on this truly bizarre fascination.
Spoiler Alert: I don’t think this has anything to do with aliens. While I do not dismiss the possibility of life in this universe more intelligent than humans, I don’t think it is coming to Earth and messing with our cows.
I have 7 years of research and thoughts on these events and there are a few options regarding what I can do with this information. The option currently in the lead:
Start An Investigative Podcast/YouTube Series With A Funny Name
I would present each individual documented event in chronological order, the information available that I’ve been able to gather, any additional leads people are able to provide, and similarities between the events that I’ve been able to observe. This would then include leads from listeners that have been followed up on in later episodes.
The reasoning behind presenting the same information in two formats is because I want to be inclusive of non-auditory individuals, and those needing closed captioning and/or lip reading to assist with auditory processing. For more information on auditory processing disorders you can visit that website or read the Wikipedia page here.
The big rule here driving my investigation: It’s Not Aliens. The perpetrators could be many things, but the response of “aliens” has become the standard cop-out. There is a lot of additional evidence, even from those that do believe aliens visit earth, to suggest these mutilations are not being performed by aliens.
I mentioned before that I have thoughts on alternative explanations. I don’t think these cases are going to be a “one explanation fits all” kind of thing. These potential explanations include: insurance fraud, publicity, public diversion from other questionable activities, ritualistic or cult activity, and intimidation. That said, I absolutely expect that there are potential explanations that I have not yet thought of. Who knows – maybe I will be proven wrong and there are aliens. I have to be open to that possibility, no matter how skeptical I am and how little I think it makes sense.
If you are interested in this kind of investigative podcast about the unsolved mysterious cow mutilations that have been ongoing throughout the United States for at least the past 50 years, please like this post and/or comment your suggestion for title of the series, what excites you the most, or if you have any thoughts you would like to contribute. If you think a friend would like to listen to this podcast or would have anything to contribute, please share this.
I’m excited to have as much input as possible in this 100% bizarre side project, even if you disagree with me and want to tell me you think I’m wrong; even if you insist that it’s aliens.
If this gains enough interest (100 likes) I will launch the first episode of the podcast.
Until then, I will continue to focus my efforts on reviews, my book becoming available for pre-order later this summer, “A Hundred Different Skies”, and my short story collection coming out early next year.
As always, thank you for reading. Without you, this post would have been meaningless electrons sent out into the void.
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!). [update 15 July 2020] A new study by the CDC also found significant reduction of transmission from 2 symptomatic hair stylists that tested positive for COVID-19, but all 139 exposed clients were protected by both the stylist and the clients wearing masks. With all this information available there are individuals still refusing to wear masks and the argument is that the reason for this denial is rooted in our culture.
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 led 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.
Consideration should also be given to variations in societal and cultural paradigms of mask usage. The contrast between face mask use as hygienic practice (ie, in many Asian countries) or as something only people who are unwell do (ie, in European and North American countries) has induced stigmatisation and racial aggravations, for which further public education is needed. One advantage of universal use of face masks is that it prevents discrimination of individuals who wear masks when unwell because everybody is wearing a mask.
At this time the adoption of universal mask usage in the United States is tenuous and has been unnecessarily politicized.
§ 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.
Masks And Accessibility
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.
Update 14 July 2020: recommendations currently stand that individuals requiring modifications to wear masks should instead self isolate and not wear the mask. These are not going to be the people attempting to show a printed off the internet ADA card while not social distancing and yelling about their rights. These individuals may have a medical letter from a doctor explaining the specifics of their condition, but this does not exempt them from wearing masks inside commercial businesses. It instead requires businesses to make accommodations, such as curbside pick up or delivery. According to the Southeast ADA Center individuals that should not be wearing masks for accessibility reasons include:
Individuals who have any respiratory condition (such as COPD, asthma, and cystic fibrosis) that may be worsened by wearing a mask.
Individuals who cannot remain calm and functional while wearing a mask due to PTSD, anxiety, claustrophobia, or other anxiety disorder. Masks have been shown to induce hyperventilation, elevated heart rate, and panic attacks in these individuals.
Individuals with Autism/Autism Spectrum Diagnoses (ASDs). Sensory hypersensitivity can induce panic in response to having the nose and mouth covered, fabric textures, and the feeling of masks touching their faces.
Mobility impairment that requires an otherwise independent individual to need assistance. Many people cannot make an assistive caregiver materialize out of nowhere and preservation of autonomy is really important.
Anyone using mouth or tongue control devices. This includes motorized chairs that use the sip and puff control mechanism.
-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?
[Updated 14 July 2020]
Numerous papers have been published establishing the effectiveness of masks in the control of the SARS-CoV-2 virus. One paper in the Lancet is titled “The Rational Use Of Face Masks During The COVID-19 Pandemic”. This paper took the time to thoroughly analyze public health responses from various countries, the reasoning behind their responses, and how this impacted the spread of the virus. While it explains that stigma is likely to be the biggest barrier, there’s still sufficient evidence from countries that did adopt a universal mask wearing policy and slow the spread.
A paper published in the BMJ sought to do a systematic review of the effectiveness masks. While arguing the precautionary principle is a wise choice in regards to public health measures and does not require “perfect evidence” or a full systematic review prior to implementation.
In conclusion, in the face of a pandemic the search for perfect evidence may be the enemy of good policy. As with parachutes for jumping out of aeroplanes,38 it is time to act without waiting for randomised controlled trial evidence.39 A recently posted preprint of a systematic review came to the same conclusion.40 Masks are simple, cheap, and potentially effective. We believe that, worn both in the home (particularly by the person showing symptoms) and also outside the home in situations where meeting others is likely (for example, shopping, public transport), they could have a substantial impact on transmission with a relatively small impact on social and economic life.
In a letter to the editor published in Infectious Disease Modeling a group discussed disease modeling performed on data sets from New York and Washington states. What they found suggests that the adoption of wearing masks will decrease the number of deaths significantly and reduce transmission.
Hypothetical mask adoption scenarios, for Washington and New York state, suggest that immediate near universal (80%) adoption of moderately (50%) effective masks could prevent on the order of 17–45% of projected deaths over two months in New York, while decreasing the peak daily death rate by 34–58%, absent other changes in epidemic dynamics. Even very weak masks (20% effective) can still be useful if the underlying transmission rate is relatively low or decreasing: In Washington, where baseline transmission is much less intense, 80% adoption of such masks could reduce mortality by 24–65% (and peak deaths 15–69%), compared to 2–9% mortality reduction in New York (peak death reduction 9–18%)
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? Here’s the thing. We’re there. We’re at the 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. That’s it.
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.”
What About Herd Immunity
I added this section in the update because I have heard arguments against mask wearing for the purpose of increasing herd immunity. Quanta Magazine wrote a great article explaining that herd immunity is complicated and how to read an R0 . For those that don’t want to read the article, I will explain it in a way I’ve used in the past for students.
Imagine you have a bouncing ball rolling around on a pool table and every time that ball hits another ball it changes that ball’s color. This change is not reversible. The number of balls that can interact and change color at a given time depends entirely on factors such as movement, density, and the total area of the pool table versus the size of the ball. Any change in those conditions is going to change the probability of interactions, and as the balls change color there are fewer available. That said, you can always add more balls, and some of them might have already changed color. You can force the balls to not go anywhere and severely reduce their interactions.
Because herd immunity’s effectiveness is dependent on the R0 (The estimated number of people being infected by an infected person / the number of balls interacting with the balls that have changed color) and that number will vary based on the conditions previously mentioned.
Herd immunity does not protect vulnerable populations effectively due to heterogeneity of R0 within a single population. Not all humans behave the same and this vastly changes how many people they can potentially infect. With necessary herd immunity estimates requiring a range of 40-60% of the United States population to have been infected to impact and reduce the spread, and an estimated death rate range of 4-6% at this time we can quickly consider what this means for a population of 328.2 million.
This means a total of 131.28 – 196.92 million Americans will need to contract COVID-19. If this happens, we can expect 5.25 – 11.82 million deaths in total by the time herd immunity is achieved unless there is vaccine intervention, assuming the death rate does not increase beyond 6% due to lack of access to medical care as ICUs hit capacity across the United States.
Wear a cloth mask. Assume good intent for everyone wearing a mask. They aren’t doing anything suspicious. Don’t call the police.
Masks work. 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. Last updated on 14 July, 2020.
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.
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.
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.
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?
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)
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.
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.
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.
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.
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?
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.
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.
(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.
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.
Do you live in an area that is severely impoverished?
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.
What is determined to be essential and how do they determine whatpercentage 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.