Heavy Thoughts AKA Things That Influence My Writing: Missing And Unidentified

Why Am I Drawn To The Stories Of Missing People?

I have a tendency to wander off – in grocery stores, in parking lots, in Costco. I get this trait from my father. At one point this led to an interesting scenario where I was 17 and in the back of a police car, but that’s a story for after I’m dead.

This is why I wear a GPS enabled watch with Find My Friends and cell service. It’s because my husband loves me and genuinely cares for my safety and is the only person on this planet that has access to that information in case he can’t find me one of these times I’ve wandered off somewhere. Flowers and books can be distracting when you’re in the woods.

There are a lot of people like me in this world. And there are a lot of people mixed up in bad 💩 one way or another. I look at these cases and I see missing people that could have been me, but I’ve always found my way back. I’ve never been lost – for some reason I have a confident sense of direction even when in wilderness areas. I can’t explain that part, but I bet many of these people felt the same way – they tripped and fell without a way for someone to find them.

I think about their families and that’s where I get stuck. I struggle with understanding extremes of emotions – I tend to shut down instead. I think about how many of those families also shut down and the generations down the line that shutting down impacts. It’s like a death with no closure – it’s so much worse because it’s unknown.

Montana has a huge number of missing persons and cold cases. A lot of these cases are children and there is some suspicion that some of these kids end up in Canada, human trafficking, (sometimes both of those), and worse.

Unidentified Remains

For more information: https://canadasmissing.ca/index-eng.htm

The world is full of unidentified bodies and missing persons. Some of the reconstruction methods for unidentified bodies are better than others – the (Combination) Manchester Method used in the video above is one of the better methods and is a more recent improvement. And all of these bodies are missing their stories.

With these newer methods we are finally putting faces to the skeletons of unidentified remains. These faces have helped family members identify lost loved ones years after their disappearance and finally put what happened to them to rest.

Last autumn I listened to The Disappearance of Des on my commute. It’s a podcast about Desmond Francis Carr – an Australian man who died in 1979. It was when I started listening to missing persons podcasts that I realized just how many unsolved disappearances. In fact, every few years a news network like NPR in 2013, or even Local News Stations in 2019 notes just how many cases go unsolved and that some states seem to have more than others – in that report Alaska, Arizona, and Oregon has the top 3 lead, with Georgia, Rhode Island, and Massachusetts having the fewest missing people per 100,000 residents.

According to NAMUS the United States has 4,400 unidentified bodies found every year and 600,000 people go missing. I think of the number of lives impacted by those 600,000 missing stories and then I realize that’s why all of those podcasts exist. That’s why people need to keep talking about these missing people.

Recent Cases In Montana

As of Friday, 56 children are missing in the state of Montana. The demographics break down as follows:

Here’s a nifty chart I made for everyone to show the comparison.

Without equal representation in both sex categories, I can’t run a full analysis, so I had to throw one of the categories out. If we focus on just the white and native children and look to see if there’s any statistically significant difference between the numbers of children missing in these groups, there isn’t (this is assuming boys and girls all have equal representation within the population).

There are going to be those that argue with me about the inaccuracies of this analysis because of the identities of these children. If the identity is impacting the way the child is now presenting to the world that’s important information that people should come forward about, but that is not information available on the sheet provided by Montana DOJ. I am working only with that information.

I ran it with a generous 95% confidence interval:

The chi-square statistic is 0.1922. The p-value is .661126. Not significant at p < .05


The chi-square statistic with Yates correction is 0.0195. The p-value is .889073. Not significant at p < .05.

There is one thing that is significant though – these populations are supposed to be statistically different. Only 6% of Montana’s population is Native American, so why are 37.5% of missing children from that demographic? If children were being selected randomly from the population, then the distribution should be proportionate to our population, not insignificantly different between the two groups.

That would mean that if missing children were proportionate we would expect only 3.36/56 missing children to be Native American versus the reality of 21/56 missing children (following the percentages mentioned above). Comparing these proportions with a one-tailed Z-test and a generous significance level of 0.05:

The value of z is -4.0403. The value of p is < .00001. The result is significant at p < .05.

NAMUS has a special program in place because of this issue. You can check out the United States Department of Justice’s data sheet here. Montana is one of the states that has not yet passed legislation mandating case entry into this database. I understand that a lot of decisions will need to be worked out.

Anyways, that’s a lot of rambling. This is a heavy subject to write about. If you have any interest in this topic consider volunteering your time to write about a missing person cold case for some form of media. There are a lot out there – more than have been written about.

Thank you for reading. Without you these little bits of data aren’t anything – communication requires a recipient and for you I am grateful.

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

If Haskell gets any closer Nyxie will show him the consequences

Yes A Does Really Have To Get To B Eventually

Cause And Effect

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

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

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

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

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

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

We Didn’t Go Anywhere

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

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

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

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

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

Characters Have Hidden Lives

It’s Okay To Have “Offensive” Characters

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

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

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

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

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

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

Your Characters Have Moods

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

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

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

Settings Are Places That Can Only Be Known Through Experience

Setting Descriptions Have A Time And Place With Characters In Them

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

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

Settings Indicate Culture

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

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

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

TL;DR

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

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

Today in “Lo Is Domestic AF”: Will It Chocolate Chip Cookie? Part 1

That’s Thai Basil Lemonade – I can do some things

I’m going to let everyone in on a little secret:

I’m not a domestic goddess

But I really like cookies and my sister has gotten me craving cookies. I blame you dear sweet sister, Becky.

Except, unlike her, I am not an angel of the kitchen. No. I create abominations behind closed doors. I present to you:

The Pillsbury Gluten-free [Cayenne Surprise] Chocolate Chip Cookie*

*not sponsored – this is what we had in the pantry

“But Lo,” You ask, “What’s the surprise if you tell us the cayenne is in it?”

Well, most people aren’t prepared for a cayenne chocolate chip cookie made with coconut oil instead of butter.

Don’t forget to preheat your oven to 375F because Pillsbury says,“🦆 the metric system!”

That’s 1/2 cup of softened coconut oil, couple dashes cayenne pepper, 1 tablespoon tap cold water, and an egg.

Blend until decently homogeneous such that unsuspecting husband cannot see the cayenne pepper flakes.

Advise him that he can taste how spicy they are if he would like. Watch as he makes his “ew that has raw egg in it” face.

Laugh on the inside as you taste it and suggest adding more. He says, “No.”

Elevation seems to impact cooking time a lot for this baking mix. At 3205 feet elevation (at MSO) the cook time is approximately 10 minutes. I have made this recipe at 6000+ feet elevation and 10 minutes was not the correct time. Both were gas ovens, but there are other variables to be aware of.

Listen, gluten-free baking is weird and I’m constantly whispering incantations like “you better work you 🦆ing box of baking soda tasting 💩 “ over it. I’m not a wizard, contrary to what my last name may lead some to believe.

Once the cookies are out you have to let them cool a little, then detach them.

Next comes the fun part – the cayenne.

Dust the cookies with cayenne then transfer to a rack to finish cooling because I obviously trust you to do the right thing. Right?

Psych! Get that second batch in the oven and get your favorite homogenized nut juice some weirdo is insisting you call nut milk. Pour a glass and get a plate with at least 2 cookies.

If you are using horchata instead, you’re the true goddess, my friend.

Like that glass? Sales of it support the survival of a community gathering place important to me. You can buy that glass here.

Are you ready?

Yay! 2/2 approve! Cayenne Surprise is the good kind.

So What’s The Surprise?

The spice sneaks up on you. The tingling starts around your lips and crawls around in your throat balanced with the flavors of chocolate and cookie. It’s subtle, but you can’t eat too many. The cayenne isn’t super noticeable visually. It adds a brightness close up. Overall, I’d say this was a success. Have you tried similar with a different chocolate chip cookie mix or recipe? How did it turn out?

What should I try to add to cookies next? Do you have another domestic potential disaster for me to attempt? Comment below!

Quarantine Writing T-Shirts Prize Discussion

In my previous post I created a writing contest. I decided to make t-shirts because I wanted t-shirts for me. I want to be able to offer a prize (the t-shirt or something with funds raised with them) to authors that submit amazing stories. There’s a poll about that here. There are three campaigns and none of them have a minimum purchase to print.

Writing in Quarantine

Not everyone is writing during Stay At Home Orders. Reading and Editing are important parts of the writing process.

Editing in Quarantine

Reading In Quarantine

I’m not interested in making money off of these t-shirts. I wanted 3 t-shirts, then realized they might make good prizes or help fund cool prizes. What do you want in exchange for writing short stories using my weird methods for navigating writer’s block that I’d post on here? Don’t forget to vote in that poll re: t-shirts.

I can also design tote bags, hats, mugs, and face masks according to Bonfire’s website, so there’s some flexibility on what I can make as a prize.

Other items I can throw in for cool prizes: random second hand copies of books I think every person should read. Porcelain teeth. A 100% unique handmade item that may or may not be pretty.

I’m bored and craving human connection. This contest is giving me human connection. Thank you.

Quarantine Writer’s Block: Exercise 1

Object Oriented Fiction Writing

How To Use An Object (Short Story // Warm Up)

Visualize an object in your mind, or better yet, look for something “weird” you own.

Nana’s embroidery project from three summer’s ago that she gave you for your birthday? Perfect!

That Betsy Johnson cat locket ring you picked up for 50 cents at a yard sale? Golden!

That polaroid you found on the sidewalk while jogging last week? Best one I’ve heard yet!

Grab it, mentally or literally. Now, forget its past. That object is now foreign to you. Write 250+ words of new, completely fake information about that object and how it relates to a story. Think about the setting transitions the object goes through. What characters handle it? What experiences does the object witness (though it has no eyes)? To follow up with the previous examples:

Who were the people in the polaroid and how did it end up on the sidewalk?

Who bought the cat ring for who? And what was put inside?

Why did that embroidery project go terribly wrong and what shenanigans did that embroidery circle get into?

Who bought the cat ring for who? And what was put inside?

How To Use An Object In A Pre-Existing Story

In every story there are objects that characters interact with and often we forget how critical we make objects for the progression of a story. Be it a quest for buried treasure (object) or the consequences of a cursed [object], there are objects that come into play each with its own unique role. To use this exercise, you could consider one of these objects in your story as your object of focus.

Thought Examples:

Arthur is not king until he has his sword and unites the Britons (every King Arthur legend ever)

The one ring to rule them all must be thrown into the fires of Mount Doom. (Lord of The Rings, JRR Tolkien)

Trisha uses her Walkman to survive the Maine wilderness. (The Girl Who Loved Tom Gordon, Stephen King)

Arts & Crafts

I have found that in severe cases of writer’s block a physical representation of the object is very helpful. In this case, break out the arts and crafts. No matter how bad the representation, having something you can physically interact with while brainstorming will help immerse you in that world. The act of creating the object can be its own helpful therapy. Also, the models that you make bring your story to life in your own mind, and could help ease writers block on their own. Put them on display in your writing zone.

Collage & Antiquing

Some authors will hunt for objects in antique stores – in the time of quarantine, antiquing is not really an option (except online). Pinterest albums and other collaging methods are much friendlier. Finding an image to create a sketch from or even print out as your representation is useful!

Write Around The Object

Now that you have the object, physically, mentally – whatever way works best for you – start thinking. Sometimes, I prefer thinking of minor objects in a particular scene I’ve been trying to write because it helps lead me into writing the scene I’ve been blocked on. There are many ways to flex your brain around the existence of objects within a story and how they are playing a role. This allows the object to be written around – it’s there to help break down the mental block.

Do I Leave It In The Story?

It’s easy to edit out anything once it has served you, but a writing exercise can get you writing when you’re struggling. I have based entire short stories on objects, and I have cut entire objects out of stories. The choice is up to the individual author and what they want out of their writing.

Exercise 1 Summary: With an object related to your story, either physical or imaginary, write at least 250 words about that object fitting it into a scene you are trying to write or relating it to your story.

Bonus: Do some arts & crafts to make a physical representation of your object.

TL;DR

  • Objects can be useful for helping your brain overcome writer’s block
  • Think about the role objects play in your story and select an object from your story to focus on.
  • Physical representations of objects in your story are sometimes helpful in overcoming writer’s block – these can be made with arts and crafts.
  • Try to write at least 250 words fitting an object into a story to overcome writer’s block.
  • You never have to leave what you have written from a writing exercise in a story.

I would love to feature your writing on my blog!

Please let me know if this helps you in the ways it has helped me! I would love to read every single short story written using this methods (100% serious). Tell me about your stories and the best ones will be featured in their own posts – please submit using the subject line: Object Oriented Writing. I am planning on getting a group of judges other than myself to read these if people actually participate. This contest will be running through 30 April, 2020.

Rules:

  • Word Count: 250 – 2000 words
  • grammar or spelling mistakes do not interrupt reading experience
  • Must be capable of being rated PG
  • Has the entire story written following the exercise above (Beginning, Middle, End, etc)
  • Please be sure to include your name or pen name, contact e-mail, and other identifying information in the body of the email.
  • Please submit your short story in a .pdf (an attachment that can be read by Google Docs) with a unique 5 digit number you pick at the top (do not include this in the e-mail). I will use these 5 digit numbers to announce winners on Twitter.
  • (Optional) include a picture of your object
  • The story cannot have been previously published elsewhere as it needs to be a new composition using the above method.
  • Author retains all rights beyond the printing of the story in a blog post on LoPotterWrites.com with any other promotional material the author provides for their writing. The author can request that the story be removed at any time should they wish by contacting me.
  • If the above rules are not followed your story will sadly be disqualified.
  • You will be notified if your story is chosen (or not) by 31 May 2020 (assuming there are not thousands of submissions).

Prize: TBD

Right now there is no prize besides having your short story on my blog. I am working on figuring out ways to improve this and how many prizes I can offer.

Thank you for reading – without you, this would be a shout into the ether.

Recovery: If 1 million Americans get coronavirus, what will the recovery look like?

Success With Flattening the Curve

I posted this on twitter last night after the briefing.

Remember how we were projected to have 2.5 Million cases? We have reduced the projected number of infected Americans by 1.5 Million to only 1 Million. 1 Million is not great, but that’s a big change. That is called flattening the curve and everyone should be thinking that is really amazing (I know I am). They did not mention the number in the briefing (frustratingly). But forecasting has gotten a bad rep in the past.

For those who are math nerds – that’s a linear fit to 1,000,000 (switch from exponential), which some dude in the early 20th century proposed was when the growth in the number of reported influenza cases was hitting it’s predictable rounded peak forecasted the maximum cumulative cases (the limit). I’ve been trying to go through my notes to remember more about how this all works because I don’t remember the name of who came up with all of this and I’m trying to find the paper. I will update this and replace this rambling text when I do.

Recovery in the US

Recovery is not a guarantee that you will not get SARS-CoV-2 again. There are recorded cases of reinfection internationally. We do not have enough data to know if this is reactivation of latent virus or if this is true reinfection. That said, we are finally looking for asymptomatic, both recovered and not, individuals.

A vaccine would be able to address this by using adjuvants designed to induce helper T cell immunity in addition to antibody based immunity. Vaccines take time. Realistically a good vaccine will be on the market in March 2021 at the absolute earliest. Anything before that I will be floored if it has sufficient efficacy to help.

In New York City, 40-50% of patients experiencing severe acute respiratory distress will be placed on a ventilator. If recovery required a ventilator, the testimonies from survivors do not suggest a population able to return to the workforce tomorrow. Shortness of breath, weakness, and other long term effects of hypoxia threaten the be permanent disabilities in this portion of the population.

But what if you do have immunity? You’ll be able to test that. What if you’re one of the lucky ones? I guess that’s up to you.

We’re in this together.

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

At each of these state clusters there is at least one urban center that has the dominant reservoir population. Once movement between urban centers (New York -> Chicago -> Houston -> Miami -> Atlanta -> Boston -> Dallas -> L.A. -> San Francisco -> Chicago -> Orlando -> Pittsburgh -> (etc. etc. etc.)) stops then there will no longer be additions of infected individuals into the populations. This is why non-essential planes need to be grounded.

I live in Montana. I am so blessed. I want to make it clear that we still need to behave. It only takes 1 person to infect 10.

My family and people I love live in Washington, Idaho, Oregon, Montana, California, Texas, Alabama, Louisiana, Florida, Virginia, New York, New Jersey, Massachusetts, New Mexico, Arizona and Maine. I’m terrified for everyone.

We’re going to gradually come to a new normal. Ask me questions and I’ll eventually address them in updates on these original posts.

As a change of pace, I’m going to stop writing about the coronavirus for a while unless there’s something people specifically think of graphs or other things that would be useful questions to be answered in something new instead of an update. I still have a backlog of a couple posts that will still get done though.

I will be starting to write short stories and weird little memoir style posts so people can enjoy my writing separate from the reviews.

Thank you for reading. Without you this is a shout into the void.

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.