Quarantine Diary, Day #2 3/14/2020

Having recently had shoulder replacement surgery...I feel a bit more vulnerable than usual. And to read I am in the high risk “old” group...I did not feel old nor vulnerable until now! Doing what I can to lower exposure possibilities...especially since I just ran a slight fever for 3 days. Now to decide: keep my physical therapy appointments and also walk at the gym...

I survived the Aids pandemic because as a gay person we knew more about it WAY before the mainstream news latched on to it... As a so called old person I'm going reckless even though as a germafobe?? I've been doing what they say to do for years... So I'll be the lab rat...

Hi Everyone, I am sure you have been following the evolution of the Covid-19 virus as it has spread through China, South Korea, Iran, Italy, and now the USA and other places in the world. We are at our cabin near Traverse City for 5 days. Hi Mary Beth - I sent my first email communication below to my entire extended family this morning Sat 03.14.20. Here is what I wrote. "Yesterday, Joe went to visit his mom at the nursing home for the first time since we were last here 6 weeks ago. By the time he left, the nursing home announced that it was closing to all visitors, including family members, until further notice. At the same time yesterday, officials of Grand Traverse County announced that all schools, colleges, and government offices would be closed. The regional hospital and area nursing homes would also be closed to all visitors. Had the US utilized the testing formula and kits offered by the World Health Organization at the beginning of February, and then followed the testing methodologies so successfully ramped up in South Korea, we would be in a far better place. But with the failure 6-weeks ago implement accurate, widespread, rapid testing, Americans have no way of knowing who is carrying the virus, and where the outbreaks are happening or are soon to happen. It is only after people get sick with the virus they contracted 10 days earlier that health officials – and the public – know that this highly contagious virus is present - a week too late. Because of this failure to test and isolate cases early on, the virus has spread among our communities without our knowing it. It is here, but we do not know where or how widely except in places where people are already sick. So now, drastic “social distancing” measures are being implemented by state/local authorities, businesses, and churches – comprehensive cancelling of school, sporting and cultural events, and liturgies – to slow down the spread of the virus which otherwise can no longer be contained. Since the beginning of the outbreak, I have spent a lot of time reading about Covid-19 from many sources. Today Stephanie Weaver, who traveled to El Salvador with me when she was at LaSalle St. Church, posted this particularly useful advice below by a physician for this new moment in which we find ourselves. I hope we all make it through this. As a hospital intensive care nurse, Joe will soon be on the front line which this physician estimates will come in April. I imagine that Andrew will be in the thick of it as well. Those of us over 60-years-old are at the highest risk. Unlike the brutal Spanish Flu in 1919, today we have online and telephone technology to keep each other informed. Gary

Mary Beth: Here is the message that I received this morning from Stephanie Weaver to which I referred in the email message to my extended family: Recommendations for living out social distancing (tips for parents especially) Asaf Bitton MD, MPH | Executive Director | Ariadne Labs, Brigham and Women's Hospital | Harvard T.H. Chan School of Public Health. (03.14.20) I know there is some confusion about what to do next in the midst of this unprecedented time of a pandemic, school closures, and widespread social disruption. I have been asked by a lot of people for my opinion, and I will provide it below based on the best information available to me today. This is my personal and well-informed opinion, and my take on the necessary steps ahead. What I can say as a physician and public health leader, is that what we do, or don't do, over the next week will have a massive impact on the local and perhaps national trajectory of coronavirus. We are only about 11 days behind Italy and generally on track to repeat what is unfortunately happening there, as well as much of the rest of Europe very soon. At this point, containment through contact tracing and testing is only part of the necessary strategy. We must move to pandemic mitigation through widespread, uncomfortable, and comprehensive social distancing. That means not only shutting down schools, work (as much as possible), group gatherings, and public events. It also means making daily choices to stay away from each other as much as possible to Flatten The Curve. Our health system will not be able to cope with the projected numbers of people who will need acute care should we not muster the fortitude and will to socially distance each other starting now. On a regular day, we have about 45k ICU beds nationally, which can be ramped up in a crisis to about 93k. Even moderate projections suggest that if current infectious trends hold, our capacity (locally and nationally) may be overwhelmed as early as mid-late April. Thus, the only set of interlinked strategies that can get us off this concerning trajectory is to work together as a community to maintain public health by staying apart. So what does this enhanced form of social distancing mean on a daily basis, when schools are cancelled? I can suggest the following: 1. No playdates, parties, sleepovers, or families visiting each other's houses. This sounds extreme because it is. We are trying to create distance between family units and between individuals across those family units. It is uncomfortable, especially for families with small children or for kids who love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take 4-5 days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky - I definitely do not recommend that people do so outside of their family. We have already taken extreme social measures to address this serious disease - let's not actively co-opt our efforts by having high levels of social interaction at people's houses instead of the schools. Again - the wisdom of early and aggressive social distancing is that it can flatten the curve above, give our health system a chance to not be overwhelmed, and eventually may reduce the length and need for longer periods of extreme social distancing later (see what has transpired in Italy and Wuhan). We need to all do our part during these times, even if it means some discomfort. 2. Take walks/runs outside, but maintain distance (ideally 6 feet between people outside your family) Try not to use public facilities like playground structures as coronavirus can live on plastic and metal for up to 3 days, and these structures aren't getting regularly cleaned. Try not to have physical contact with people outside of your family. Going outside will be important during these strange times, and the weather is improving. Go outside every day if you can but stay physically away from others. Try not to have kids play with each other (even outside) if that means direct physical contact. Even basketball or soccer involve direct contact and cannot be recommended. If people wish to go outside and have a picnic with other families, I strongly recommend keeping distance of at least 6 feet, not sharing any food at all, and not having direct physical contact. Invariably, that is hard with kids, so these shared, "distant" picnics may be tricky. Do not visit nursing homes or other areas where large numbers of the elderly reside, as they are at highest risk for complications and mortality from coronavirus. We need to find alternate ways to reduce social isolation in these communities through virtual means instead of physical in-person visits. 3. Reduce the frequency of going to stores/restaurants/coffee shops for the time being. Of course trips to the grocery store will be necessary, but try to limit them and go at times when less busy. Consider wearing gloves (not medical - but perhaps washable) and of course washing hands before and after really well. Leave the medical masks and gloves for the medical professionals - we need them. Maintain social distance from folks. Take-out meals and food are riskier than making food at home given the links between the people who prepare food, transport the food, and you. It is hard to know how much that risk is, but it is is certainly higher than making it at home. 4. If you are sick, definitely stay home and contact a medical professional. If you are sick, you should try isolate yourself from the rest of your family within your house as best as you can. If you have questions about whether you qualify or should get a coronavirus test, you can call you primary care team and/or consider calling the Partners Health Care hotline staffed 8AM-8PM every day - 617 724 7000, or the Massachusetts department of public health at 617 983 6800. Don't just walk in to an ambulatory clinic - call first. Obviously if it is an emergency call 911. (Obviously, this is for people in Boston only) 5. We need to push our local, state, and national leaders to close ALL schools, events, gatherings, and public spaces now. A local, town by town response won't have the needed effect. We need a statewide, nationwide approach in these trying times. Contact your representative and the governor to urge them to enact statewide closures. Also urge them to fund emergency preparedness and make increasing coronavirus testing capacity an immediate and top priority. I realize there is a lot built into these suggestions, and that they represent a real burden for many people, businesses, and communities. Social distancing is hard and may negatively impact others, especially those who face vulnerabilities in our society. I recognize that there is structural and social inequity built in and around social distancing recommendations. We can and must take steps to bolster our community response to people who face food insecurity, domestic violence, and housing challenges, along with the many other social inequities. I also realize that not everyone can do everything. But we have to try our absolute best as a community, starting today. It is a public health imperative. If we don't do this now voluntarily, it will become necessary later involuntarily, when the potential benefits will be much less than doing so right now. Asaf Asaf Bitton MD, MPH | Executive Director | Ariadne Labs Brigham and Women's Hospital | Harvard”

Thank you. Much grace to us all. Patricia/Fl

Thanks for this message from Asaf. It reinforces our decision to hunker down at home for the duration. I was in captivity at home all last winter with a broken ankle and it was wonderful! I'm actually looking forward to the break from our usual frenetic activity but do feel sympathy for those who don't have that luxury or who are more socially oriented than I am.

What most concerns me about everyone going full-on quarantine is that (I feel) intelligent people have stopped thinking for themselves--checking in with their values, their intuition, and their guts. Rather, we are following orders blindly (often because we have to, but still following nonetheless). I think back to other crises in our not-so-distant past when the government was "doing what's right for everyone" and, yeah, that didn't go so well. It's hard to find truth & facts in this type of climate, with lay people spouting statistics like they're scientists and scientists giving advice that differs from their colleagues. It's frustrating that people are so "black and white" in their thinking that we have to enact all-or-nothing policies. So, yeah. I'm grappling with my need to THINK, then act -- and not having enough trustworthy outlets to get information that allows me to think. I'd like to see more dialogue among intelligent people about the ways in which the government forces us to live according to herd mindset, and less dialogue about all the fun ways in which we can wash our hands. (I already know how to wash my hands!!) I'd like for us to be able to hold two desires at the same time (wanting to keep others safe + wanting to remain in community are two that come to mind) AND to be able to share that we hold those two desires. I'd like for there to be more AWARENESS of how debilitating this quarantine is to anyone who basically isn't white & privileged (I am, btw). I'd like for teachers & parents to show Way More Recognition that learning can take place OFFline. That it often, does, in fact, take place naturally--in the real world--when technology isn't available. When kids are forced to use their brains (something we adults are having trouble doing! Gee, I wonder why...). When kids are "bored." When kids have to get resourceful because their mom/dad is busy right now so please just go away and find something to do...!! I'd like to see more women pick up the phone to make a call than reserve a "virtual" conference room to still be able to interact with each other. I'd like to see people sharing toilet paper instead of fighting over it. (Wrapped TP, obvi) I'd like to receive feedback that I'm not the only one who sees the sham behind all the precautions (actually there was a Slate.com article that made me feel better), and I'd like to feel like I can talk about this with other human beings without being ostracized because I don't blindly follow rules. (Wow, thanks for letting me vent, Mary Beth!)

LeeLee, I agree with much of what you have written. It is so hard to know that the information we are hearing is, in fact, real, actual truths. Sometimes it seems that we are more easily controlled as a society if we are keep apart, uninformed and given a healthy dose of false information. I am angry that the testing requested last week by doctors was ignored. Our nation did not approach this with the proper attention such a horrific problem required. But that anger and frustration does not help my immune system. Signed, Another Old Lady (AOL)