Category Archives: Medical

Herd Immunity

Holly Doyne Posted on by 3

This is a rant – delete at will.

Before I even go down the trail of why this new plan of the US White House is immoral, obscene, and not even remotely ethical – let us talk about herds.

Herds are groups of bovine or related species.  There is absolutely no question in the herd that all are not equal, not all members have equal chance at survival, that there is limited ability to protect the most vulnerable members of the herd. It is Darwin at the finest. The weakest members can and are left behind. They are brought down by predators while the rest of the herd escapes. A balance of nature – so to speak. If a member of a wild herd gets a serious infection – it dies. A newly born member of the herd, if physically “defective” dies. The elderly members, especially those past reproductive age, who can’t keep up with the herd – die.

As humans – we like to pretend that we are not herd animals. We care for our young, long past the point in most societies where children born with defects are left outside for the elements. We have antibiotics and treat all those infections that we can. We don’t routinely discard members of society who are past childbearing age so that there is enough food for those who are perpetuating the species (not going down this rabbit hole at the present – as there are way too may locations in the world where grandparents are raising their grandchildren). We pride ourselves on care and respect for our elderly, elders, and aged.

Or, I thought we did. That we were not a herd.

So why would we pretend that it is perfectly all right for us to say that “let the disease spread while those who are vulnerable are protected”?

Is this idea finding root now because one person has survived his episode of COVID-19 with a level of medical support that is not available to the vast majority of the US -especially those of us who live in areas where the hospital infrastructure is old, crumbling, inadequate, and lacks even remotely current ventilation standards?

Is it because the vast majority of deaths thus far have been in aged care facilities, nursing homes, residential homes, poor neighborhoods, essential workers of color? Do those in certain places assume that their whiteness, their economic status, their privilege will protect them? Their families.

Is it because it is easy to assume that SARS-COV2 is a one and done? How easy is it to ignore the reality of long-haul COVID and the thousands upon thousands who will be living with the consequences for years.

Does someone, somewhere think that we can identify who is vulnerable? That we have enough trained personnel to staff our hospitals and care facilities to take care of that 60% of the population getting infected that it will take?

Are we willing to accept that – with our current best medical care available to all – that the death rate is about 4%? That, my friends, translates to 12 MILLION people dying in the US. Our current US death count is just past 220,000.  Look around you – that means that 1/25 of those you know would be sacrificed to herd immunity. Does your family – including partners, parents, off-spring, siblings – number 25?  Who are you willing to let die for the cause? How about your friends, colleagues? How about you? Are you willing to die to promote herd immunity?

This disease is real. It is deadly.   All those scientist who signed the Barrington? All I can think of is that they don’t view themselves at risk. That they are sure they can protect themselves. I can play with numbers. But as a physician – those numbers have human faces; dreams, families, futures. Do I, sitting behind a computer and playing with numbers have a right to say – you get to die so that others can have a “normal” life?

The long term consequences of this disease are ugly in human life, in disability, in economic cost. No one who survives an intensive care unit stay ever returns to full normalcy. The idea that political leaders could advocate sacrificing a portion of the US population to death so that they don’t have to wear a mask is ludicrous.

Excuse me – but I think we have been here before in history. When a particular movement decided that cleaning house would be advantageous to themselves, their beliefs, and their economy. The result?

We call it the Holocaust.

And now? Will we go down the same path using a disease rather than ovens?

Think about it.

 

 

 

 

New light

Holly Doyne Posted on by

is being shed on me.

Ok, I decided to not get too far into the puns. Just to relate that I purchased (thank you Amazon) a new small lamp to sit next to my chair in the living room.

simple, useful…



Oh, of course it was on sale. But it has several important features – like a long cord, two outlets and 4 USB plugs besides having a lovely and bright light which I can direct toward my computer, reading, or stitching.

Otherwise, it has been a Webinar day – starting at 0600 which is too early for any reasonable human being (but corresponds to a reasonable time for the speakers in the Philippines and South Africa). I guess I should just be glad that I am not living in Hawaii… 

Tomorrow will be more of the same. The great thing about virtual meetings? Among others of course, is that I can listen, learn, and stitch or knit at the same time. Multi-tasking!

Speaking of which – 

 

UCSF Medical Grand Rounds

Holly Doyne Posted on by 2

Since the start of the SARS-COV2 Pandemic, the regular Medicine Grand Rounds have been co-opted by COVID-19 epidemiology, research, medications, treatments, and the like. Thursdays at noon saw hundreds of us linked in by Zoom to hear the latest which was not always the greatest or good news. 

UCSF stands for University of California – San Francisco and is comprised of a hospital system, dental, research, and the affiliated professional schools. Where I did my undergraduate and medical education – University of Minnesota – everything was more or less located on the same campus. As a result, there was a lot of cross-course work between basic sciences, public health, and the medical/dental/nursing schools. Not so here in the Bay Area where much of the basic science graduated programs and the School of Public Health are at UCBerkeley (aka CAL) across the bay and about an hour + by public transportation. 

Prior to the pandemic, there was little participation from my side of the Bay in UCSF weekly educational activities – the travel time just made it prohibitive. Now? Zoom, my friends, ZOOM.

Anyway – the usual Tues Grand Rounds were preempted today by a discussion of current status of COVID-19 as it relates to certain events of this past week and weekend. It was a moderated, good, free wheeling discussion of actions, testing, current treatments, and how you manage all of those. 

The link is here

If, for any reason you happen to think that wandering around (at least anywhere there is ongoing transmission) without a mask – you might want to watch and see a discussion of what happens when people blatantly disregard common sense and medical recommendations.  

(FYI – the rounds are posted on YouTube that evening if you are interested in a bit of pandemic history as it developed in the US).

In more fun stuff – stitching progress –

Un-pik’d

Holly Doyne Posted on by  
Since we all have come to the conclusion that, whatever it was that went wrong for George in early June – it is probably not infectious – he doesn’t need the pik line anymore.  He has been off the IV antibiotics for more than a week with no change. So today – I got to drive him to UCSF so that he could check in with the Infusion Center. They confirmed he was fine and pulled the line.

Followed by pressure dressing x 30 minutes just to make sure that there was no bleeding around the insertion site in his arm.

Which means that Noah and I hung out for about 90 minutes all together. Since we found a nice, free, shady spot in Golden Gate Park it was not as onerous as it could have been. He had his phone + ear buds. I had the baseball game + stitching.

The As won, which was just the icing on the cake.

Or perhaps the icing is that George is fixing dinner while I sit here and type.

Not a popular opinion

Holly Doyne Posted on by  

And no, this is not about politics, per se.

I was listening to an interesting Webinar from the One Health group at CDC. Ok, fine. Talk about those things which affect all parts of the biosphere; plants, animals, people. So far, so good. But then the discussion went on to the subject of animal care/pet care/companion care in the face of disaster.

I am still good. But wait – there are huge amount of precautions recommended for anyone who has the misfortune to develop COVID-19 and has animals. 

Let us stop and think (excluding the rapid spread of SARS-COV2 in mink farms in the Netherlands – that is its own problem and will be gone by 2024 anyway when the farms are outlawed) – according to conservative estimates – there have been at least 19 million cases of COVID-19 in humans. Deaths are well above 155,000 in the US alone. Look at those numbers for a moment. Think about them. 

Now, consider that there have ben 42 (forty-two, no trailing zeros) documented cases in pets (and not all in the US). That is 42. And how many of the 4+ million in the US who have been diagnosed have pets? 

The following is my personal take – and NOT the official CDC guidance

Do not isolate yourself from your pet if you are ill. You need them and they need you. Do NOT drop your pet off at a shelter just because you have a positive test. If you are too ill to take care of it, you are probably too ill to take care of your self. Make the appropriate arrangements for both of you. 

I am more concerned about those living alone who land in hospital – and haven’t made arrangements for their animals. The same way that pets/companions need to be considered when hurricane, tornado. or earth quake strikes, But this particular disease is not the same at all. Any pet who goes out side is at much greater risk of parasites and worms than they are from catching COVID-19 from you…. Please be sensible

Radio Silence

Holly Doyne Posted on by 1
Doesn’t mean that there is anything wrong.

Rather it means that the days are blurring into each other such that I (imagine this) can’t work up the energy to put fingers to keyboard. Part of that reason is that if I sit down to type, I really should be putting the finishing touches on “that paper” rather than chasing news or talking with friends.

Or reading books, exploring YouTube or any of the myriad other things that are oh, so tempting and completely and totally non-productive.

I am trying to avoid checking the news more than once a day. It doesn’t help at all. Especially since the US numbers are so totally out of whack with what is actually happening. The Worldometer, for example, is now listing tests run. Which, as it turns out, is a totally useless number. Why? It is tests. It is not individuals, which means that the number includes multiple samples for some, it includes post-infection clearing tests, etc. So it is not an accurate number at all of what is actually going on. But what it does is artificially make it look like the US is doing an adequate amount of testing (it is not) and that most people who get tested don’t have COVID-19. That also may be a very false assumption.

The other thing of concern, which doesn’t show up at all in those numbers is that California, for example, wound up more than 70,000 tests behind. Yes, that is right – 70k worth of tests sitting in the queue. I don’t know enough about the specific procedures to be completely confident that a sample that has been sitting and waiting for more than a week is going to be either a true-positive, or a true-negative. And frankly, a result coming back a week later isn’t of a whole lot of use. If you were the person who was tested, and not all that ill, you have gone on with your life. If you were in hospital, you were treated as if you were positive anyway.

Testing is best used for early diagnosis and prompt isolation/contact tracing. Even with social distancing, how many of us know exactly where we have been every minute of the day for the last seven days? Was there a grocery run? A stop to pick up meds? Costco? Target? Other box store? How about fuel for your vehicle if you drive one?

And if you weren’t sure – this is social distancing ….

as practiced by Onyx and Ghost

Jury Duty?

Holly Doyne Posted on by 4
really?

In the middle of everything, the computers of Alameda County grind on. Unsupervised, or just automated, the printer is spewing out Jury Duty summons. I received one last month, but the courts shut down before my report date. George received his summons on Monday. As I remember correctly, he was in the hospital last fall when his number came up. He called them and explained that 1) bone marrow transplant in hospital 2) house bound for a minimum of 100 days afterwards 3) recommendations for avoidance of extremely close quarters for at least six months. No problems, they would take him off the list permanently for medical.

And another summons shows up.

Perhaps they are leaning forward and hoping that the courts will be back open next month. Not. Going. To. Happen. The best modeling predicts things are going to be extremely ugly right about then. And, in any case, there is no way that he should take that kind of risk. Not unless the judicial system can go to Zoom courts…

Think about it – Anything that doesn’t require physically passing something around could be done by Zoom/GoToMeeting or one of the other softwares that link people in video conferencing. Certainly the courts could easily blow through all of the traffic tickets that way without requiring personal appearances. Effective use of both court and law enforcement time. For that matter, it would mean that people would not have to waste an entire day sitting on a bench just in case their number comes up.

Right to a trial by your peers? Ok. Where does it say that those peers have to be in the same room with you? Where does it say that you have the right to reach out and touch someone? If we can manage to support thousands of people through tele-medicine, why can’t we think ahead and set up tele-courts?

And before anyone goes down the rabbit hole about advantages to the wealthy and disadvantage to those of age, color, or poverty – exactly who do we think is tying up the court system (outside of family court) right now? It isn’t grandma on her old age pension, it is the dude with money. It is the larger landlords who have the money to evict their tenants, it is the insurance companies that would rather fight than pay claims.

But anyway…I am thinking of the waste of computer time, paper, ink, postal services for something that can’t happen next month. And this just may be symptomatic of all those automatic systems in place. The ones that let us do dumb things more quickly….

Meanwhile, “the paper” grinds slowly on. Miriam continues to build webpages as part of her “work remotely,” Shana is being the demo model for the local BAR Method’s move to Zoom Classes. Noah is on his way back to San Diego as he has lab classes when the quarter resumes next week. Angel is hard at work – more than half the staff where he works are now either out or gone and people want bagels, Alex is putting together some on-line activities for groups of JCC kids now locked down at home, Dani’s work is shut down – so she is hunting for on-line employment.

As the numbers today went over ½ a million that have tested positive, the curve is slowing only in a few locations. The US has passed Italy for total number of cases. Both Italy and Switzerland are reporting over 1000 cases per million inhabitants; and not everyone who is ill is getting tested. I think that is lot more realistic. California is still lagging hugely in testing, Ignorance doesn’t help; in my area it leads to complacencies.

Masks

Holly Doyne Posted on by 4
I was going to try and be nice and sociable, not ranting anymore. Especially since I have been told to “drop me, you are too negative” by several who have been on my email list for years.

But then I have been hit from multiple sides by do-gooders who think it is a wonderful idea to make masks at home. This is the equivalent of knitting socks & hats for the troops, only not as good or effective. Knitting socks & hats kept those not involved happy, busy, and feeling like they were contributing to the war effort. In modern times, that connection was probably even more important as, with the ending of most countries drafts, fewer and fewer citizens served, knew anyone who served, or anyone who was serving.

Connection is good.

But a false sense of security is an extreme health risk for everyone.

Down the rabbit hole:

Why does anyone wear a mask in a medical setting?

Surgical masks are worn in a medical setting to protect others from YOU. Repeat, the mask protects those around you from whatever droplets/particles you might be producing. In order to be effective, the mask must be of specified materials that left through the minimum amount of anything. Breath goes through, aerosols, for the most part do not. Medical personnel wear them routinely in specified settings, understanding both the reasons for the wear and the limitations of a mask. The medical personnel are wearing masks to 1) protect you from anything they might have – in which case, something might be better than nothing 2) to protect them from you – and a face shield is probably better than a mask.

M95 masks, so named because they filter out 95%, are denser, have to be fitted closely, are uncomfortable to wear and have a limited life span (about 4 hours). There are requirements for fitting, wearing, and handling. Frankly, the industrial painters masks are very similar, but not completely the same.

From there you go to enclosed systems which completely cover the nose and mouth, delivering “packaged” air or O2 such as airline respirators or scuba gear. Since you aren’t breathing anything from your surroundings, you don’t get anything from your surroundings. Until you take the equipment off and don’t handle decontamination properly (normally not an issue).

So why I am so upset about people making their own?
1) there is absolutely no evidence that home made masks will do good.
2) there is abundant evidence that hand made masks can do harm

If wearing something on your face gives you a sense of security – remember, that masks protects other from YOU. If you need a mask, you need to be home. Period. Full stop. Not out potentially exposing others. If you are wearing something home made, it is not going to protect you from others. And it is not going to protect them from you. And frankly, neither is that surgical mask worn by someone else for day after day. So making/wearing a homemade mask gives a false sense of security. See one on someone else? Give them a wide berth. Same as if you see someone wearing a mask over their mouth, but not their nose. Breath in through the nose? Right….

At this point, the New York Times (for US) is probably a better source of information than the CDC. It is becoming increasingly obvious that the US current administration deliberately underplayed the seriousness of what could potentially happen. The NYT webpages about corona virus are free; they are not political. And, even if you are an extremely conservative person, the NYT is not slanting the news.

The US is at 29k+ cases; deaths in 33 states. 316k+ cases world wide. Before anyone thinks that “what is happening in Italy is not going to happen here” just remember they are at least one incubation period, and probably 2-3 incubation cycles ahead of us.  Canada is hunkering down, as is Australia. Germany, Spain, France have been there for days. You can’t get an accurate reading from any of the numbers except to see how they are growing. As the epidemic spreads, testing in many countries is only applied to those who are sick. Figure that numbers for most countries are significantly lower than the actual number of cases.

But back to masks. If you are not comfortable going out without a mask, stay home. If you can’t stay home, stay away from other people as much as humanly possible. Wash your hands frequently, don’t touch your face, nose, and mouth. Even ordinary mittens and gloves worn on your hands will prevent you from picking up whatever is on that grocery cart handle. Just take them off properly. Wash, repeat. Bring your own bags. Cancel unnecessary meetings, trips. Stay away from medical sites unless you are actually and significantly sick – then follow the appropriate directions–whether they be “call ahead,” “go through the tent,” “stand 2 meters from everyone else.” Avoid those acting like obvious idiots.

Reach out to family and friends. Make a phone call, a FaceTime, Skype, Zoom, WhatsApp check in. If you are young and healthy, run errands for those who are not. If, like me, you are high risk, restrain yourself from being stupid.

And masks? Batman, Superman, Zombie are equally effective as anything you can make (baring access to medical grade materiel) and a lot more entertaining….

*Many hospitals are NOT accepting donated masks. The few that are have been very clear about specifics – two layers of tightly woven 100% cotton fabric with a layer of cotton batting in-between. Prewash the fabric, wash the mask after making. These masks may wind up going through hospital laundry at 60*C. Artificial fibers melting would not be good for the washing machines.

Of much more use are a couple of companies that have developed patterns for 3D printed face shields…

What is that NOISE?

Holly Doyne Posted on by
Miriam and I are sitting at the large table ensconced at our computers. She is obviously working at home. I am, almost as obviously, not particularly working. There is an incredibly loud screech which repeats. Yes, we have redwoods and other trees around us, home to squirrels and the occasional birds nest. But nothing that sounds like that. What is more, it seems to be coming from inside the living room.

All is quiet for about five minutes, then a few repeats.

Oh, (blinding flash of the obvious), yes. I have a tab on my browser open to this particular YouTube channel.

My plan for today is simple – a few more pages on my paper, some stitching, welcoming Noah home (his flight from San Diego which left at 0715 this morning) had only 18 passengers. I don’t think SouthWest really had to enforce boarding order. Every one had several rows to themselves. If I am really ambitious I will finish clearing off our large table. With this many people in the house + the Eldest who lives close + College Guy, it is reasonable to use a table that easily seats eight.

Corona Virus

While many people are banding together, supporting their neighbors and using social media responsibly, there are plenty who aren’t. Which means all of us need to be quiet, but firm. This is NOT a hoax. The disease, with reasonable infectivity (no where near that of measles) is spreading rapidly. If the distancing measures put in place have the intended effect, we will not see it for 14-28 days (two incubation periods). Most people become ill sooner than 14 days, but there is a range.

There are more sources of bad information and rumors than there are accurate. One of the challenges in the rush to share data in the medical community is that the whole peer-review process is being skipped. What this means for all of us is the following:

1) the authors are doing their best to provide what they know in an effort to help educate and further care and treatment of COVID-19 patients

2) no one has checked to see if the methodology (patient selection, lab reporting, etc) used in the “study” meets scientific method, valid analysis or even common sense. This process weeds out a lot of marginal information that does not prove to be valid on a second go.

3) the general press is hungry for anything they can find and report. So a study that may/may nat provide information that is medically valid gets picked up and circulated widely by and to people who have no idea of what really underlies the report.

Example – YOUNG PEOPLE AT RISK FROM CORONA VIRUS!!! the xxxx report (and unfortunately, CDC is partly to blame for this mess) says that XX% of ICU patients are young adults!

Somewhere down in the report, if you read the report and not just the headline and first three paragraphs, you will find that the age grouping for “young” is 20-50 in one report and 20-64 in another.

Hello? I do not consider those in their 30s, 40s, 50s as young adults. They are adult. Period. Normally a young adult is someone in that transition period from secondary school through University to first job. Maybe 18-23/25. I checked this with Miriam who is waiting for a conference call to start. She gave me the above number. I gave her back the age range actually used in the paper. When she was done chocking, her response was – anything about that is AN ADULT.

Perhaps the intention of the wording was to engage the Florida spring break crew – but that is not the job of the scientific community. Our job is to clearly and accurately present the facts as we know them. Grouping individuals into age bands is common. But grouping 30 + years is deceiving. Yes, the numbers are so low as to be not useful for the under 50 (especially if you eliminate the health care providers), but that doesn’t excuse poor analysis and worse writing.

The World diagnosed numbers exceeded 258,800+ by 1600 (GMT) and deaths are now over 10k world wide. This is still fewer than the US alone has had die from Influenza this year. There might be an island out there that is unaffected, but complete disease sparing of anywhere is becoming less and less likely. Even the “ocean floating boat community” which considers itself exempt from most societal constraints is not going to be able to dodge this one – everyone has to dock for supplies sooner or later.

Extra vitamins, anti-malaria drugs, dietary supplements, herbal remedies are not going to magically protect you. Taking care of yourself, avoiding crowds and those that are coughing/ill, and washing your hands are all proven to decrease your chances of disease.

Off-soap box for now!

Shelter in Place – Day 2

Holly Doyne Posted on by 2
To sum up this day –

Corona Virus-

The Chinese are now seeing more imported cases than local transmission… which means vigilance but not hysteria.
The Germans & French are having increasing numbers of cases (exactly as one would predict based on transmission curves. The numbers, I think, also accurately reflect an extensive amount of testing.
The Italians are in a world of hurt. Not only are they out of hospital beds, intensive care facilities, but illness is now breaking out in health care workers. The two main tracking sites –

Worldmeter site – by country breakdown

and Johns Hopkins University – if you really like maps rather than tables

no longer have updates from Italy.

The world total will be over 230k by the time you read this. The US is now over 10k in cases. This is probably a gross underestimate – you can get tested if 1) you know someone 2) you are a celebrity 3) you are “important” politically. Believe it or not – there have been challenges for ill health care worker getting tested.

The same idiots are proposing to activate the USNS Mercy and the USNS Comfort. No surprise, it would be at least a month; non-active ships are non-active ships. Secondly – exactly where are those health care workers coming from? The answer, of course is Navy military facilities in DC, VA, CA which are currently supporting active duty, families, and some limited numbers of retirees. It is not like the local community is going to have any capacity to absorb these patient populations.

[edited to correct ship names on 20 March, thanks to Steve, my upstate NY navy buddy who also notes that “Mercy was in the midst of an overhaul, and I think Comfort is too.  They are owned by the Navy, staffed with Civilians, and a combo of medical personal.”]

Ignore any SPAM you get which promises a cure, a medication, or supplements, vitamins or any other “sure fire way” to cure your ills. Snake oil is snake oil.

The same way – all the surfaces tests have documented that viral PARTICLES can be found for hours afterwards. Infectivity hasn’t been proven. If we test any surface, we can find virus and bacteria. So be smart, take your shoes off at the door, wear sensible clothing, keep your fingers out of your month. But don’t wash your books, hug strangers or cough on people.

Family & Friends

Thank you to everyone who has checked in. It is good to know that people are ok, keeping themselves entertained (all of us old folks are hunkered down, while the younger generation is busy taking care. of themselves, their families and the community around them). So far I have heard from France, Germany, the UK, Canada, Australia, with further reassurance about family members in far flung regions (Korea, Indonesia, Central and South America). We are a small world, thanks to electronic communications.

UCBerkeley has moved all courses on-line that it can. Some courses (science labs, theater, art, music) just don’t lend themselves as well.  We are still waiting to hear what UCSan Diego is going to do at the quarter start. Since Noah has both physics and engineering classes – completely on-line just isn’t a possibility.

For those of you who enjoy classical music – this data base covers a wide range of free streaming options from chamber orchestra to opera to full up symphony.

I wrote a whole page on my paper – then spent the rest of the day on various cross stitch projects. I am now 20k/76K completed on Farewell to Anger

20k stitches complete – 18 March 2020

the several Stitch A Longs (aka SALs) are caught up and I should not start anything new….

 

 

Shelter in Place – 1

Holly Doyne Posted on by
Do any of you remember that wonderful story that floated around the internet years ago about dog vs cat in their outlook in life?

The one that presented a day in the life of – the dog –

0700 – my people are up – just the best!

0730 – food – the best time of day!

0830 – walkies! – just the best!

etc

As apposed to the cat –

0700 – this is the 436th day of my captivity

0730 – perhaps I will lie on the stairs and trip one of my captors….

Well – this is the first day of our captivity in the SF Bay Area. It is not like I was going much of anywhere in the last couple of week. Well, other than running errands for just about everyone in the family. But still – I could run errands for myself which meant stops at important places like JoAnns and Micheals. And the Dublin Sewing Center, Stone Mountain and Daughters, and book stores and…. you get the idea

Now, I am not at all adverse to reasonable attempts to slow down Corona Virus (which, the US President aside – has absolutely NOTHING to do with Mexican Beer). Flattening the curve will spread out the burden on the health care system. That is reality.

What is also reality is that this a virus that spreads just like a common cold through a fall kindergarten class. It is going to spread. Most people are going to get it sooner or later, What we are trying to do is make that “later” happen as far in the future as possible.

The other part of the reality is the economic devastation. If you are someone who enjoys history, perhaps tries to learn from history and is wondering if this virus is going to be comparable to one of the ten plagues visited on Egypt from the Passover Story  – I direct you to Dorothy Armstrong’s The Black Death: The World’s Most Devastating Plague.  It is one of the Great Courses, available through Audible, several other sources, and perhaps your public library. It was a US public TV series in 2016 (available through Amazon Prime) and on DvD. More than just talk about the medical and health aspects – she looks at the economic, social, and political changes that were the result disease spread, lives lost, fear, hate, and complete societal changes. The entirety of Europe, as well as most of the Far East permanently changed.

Perhaps you would also like to think about the 1917-18 Influenza pandemic which helped bring WWI to a close. Or the 1956 or 1968 Pandemics.. Oh, wait! Most of us were fairly young then and lived through them with little bump in our lives.

What is going to be important about this epidemic is, in the final accounting – not going to be the virus, but how we, as a society respond and recover. It is going to take years to decades to come back from what has already happened. Every week that shut downs continue, millions more will be economically devastated in the “Western” world.  Every month adds at least a year to that recovery period. We are so used to expecting medical “miracles” that being locked down for 18+ months just stuns everyone. And, if we do that – lock down time after time, there will be little left at the end.

Only one of our “chicks” is out of area right now – Noah is finishing his exams at UCSan Diego on Thurs and will be home on Friday. The rest are now all local. Everyone is healthy, bored. I now have three off work (two daughters, one SIL), one headed to work everyone morning, and one working from home.  George can continue, as he has for over a year now, to work over phone and internet. We are lucky. The house is paid for. My income is assured unless the US government completely fails (in which case there will be more serious problems than the local government demanding property taxes.

I would appreciate knowing that you are all right and safe as you have time.

I have a number of essays written over the last month which I will take off private in the next couple of days.

 

At least it wasn’t the fridge

Holly Doyne Posted on by  
There is a semiserious joke among docs that any individual who, in putting their keys in a safe place, dumps them in the freezer warrants a dementia evaluation.

On that scale, forgetting my phone and headset in the SFVA Infusion Center is hardly cause for concern. To tell you the truth, I thought I had dumped them in my backpack. Since my Clipper Card was in my back pocket, i didn’t notice their absence until after I was on the 38R and two stops down Geary.

Deep sigh.

Disembark.

Hike back to the VA.

Back up the stairs, retrieve items from the amused nursing staff. Back down the hill, catch the next 38R. Since I had gotten extra exercise, I decided to get off a stop or so early once we hit downtown and headed to Frena’s Bakery.

I deserved goodies right?

Armed with desert for the evening, I caught BART at Powell and headed home.

And better

Holly Doyne Posted on by  
We left home right before 0700, stopped at Peet’s for coffee, at NB Bart for a passenger and hit the road for UCSF. We were there, parked, checked in before 0800. Which meant we were out of there (lab draw, visit and all), on the road, and home via Acme Bakery by 1000.

What should be obvious is that everything is going extremely well. Blood count is stable, platelets continue to slowly climb, and George is gradually feeling more energetic.

Otherwise, I am rapidly becoming addicted to cross-stitch once again. Or rather, Ranald Spangler’s Dragonlings. After all, who could resist “The Mystery of the Empty Cookie Jar” by Dragatha Christie? It is only 65 stitches wide – but 373 long so it might take a while (90 colors and few blocks color).

Worth the wait

Holly Doyne Posted on by 11
I always start the drive to UCSF with both fascination and dread. Fascination for what challenges will be on offer: from insane drivers totally senseless sludging of traffic to the death defying exploits of those totally crazy enough to drive motorcycles between lanes from frustrated individuals with a time limited destination in mind. The dread (not dead as my spell checker keeps wanting to insert) portion of my mental state comes from not knowing what we will find at our destination.

I mentioned that Miriam is in town which makes for a slightly shorter trip (although the stop at Peet’s has the added Chai for her) as we don’t have to stop at the North Berkeley ride share.

Today was well worth the drive and what seems like a forever wait while the lab does it’s fancy tests. No issues, no need for blood transfusion. Even better? It seems like the newly invested stem cells have turned to the task of settling in and are done arguing about who does what, why and where. Platelet production has apparently been deemed as appropriate as an acceptable task. This is the first time since early August  he has escaped without having a platelet transfusion.  A jump from 17 to 34 might not seem like a lot in the grand scheme of things. But considering the last time he had any increase was in June…..

Anyway, due to the Poppy wearing holiday being celebrated on Monday, his next visit is scheduled for Tuesday.

I had planned on heading over to UCHastings for a noon time seminar. But then, I had registered on the premise of both blood and platelet transfusions were likely to be in the offering. Instead, I sent mental apologies winging their way to the event organizers as we headed to the freeway and the road home.

Only Platelets

Holly Doyne Posted on by  
It wasn’t a difficult trip into San Francisco this morning. We have Miriam in town which means automatic access to the HOV lane without having to detour to the Ride Share at North Berkeley. I took that time spared and spent it on a run past the Berkeley Public Library to return three books before I had an overdue issue.

Parking at UCSF, the two of them headed up to the clinic while I took the N-Judah to Civic Center in an attempt to resolve some paperwork at UCHastings followed by sometime in the law library.

Returning to join them, it turned out George only needed platelets, so it was a much shorter stay in the infusion center than I initially thought. The time save, however was more than lost on the way home as the traffic was backed up to the freeway entrance. I absolutely detest San Francisco traffic. I don’t mind the trucks and delivery vehicles, they have a reason to be on the road. But all those cars with one person each, that idiot so busy chatting on their cell phone that they can’t responsibility drive? No, I don’t care for them at all….

A fist full of pills

Holly Doyne Posted on by 7
and more than once a day.

I will admit that I was thrilled to learn yesterday that it is time to back down on one of George’s meds. This decrease, then stopping the med will result in NINE (yes, nine) fewer capsules a day. Not an insignificant drop. At the same time, other than the absence of the bright, cheerful orange and blue, he will still be left with a lot of pills.

the most are in the morning

It falls to me, first thing in the morning, to set up the pill dispenser. After that, it is up to George to take his meds. Alarms from one’s phone can serve as great reminders. He has a bit more energy everyday. I have been having growing exhaustion. Today’s plan is for me to get some sleep!

Halloween

Holly Doyne Posted on by 5
Which wasn’t the first thing on my mind as we headed across the Bay Bridge to UCSF. After only one extra trip in, George is back on the Mon/Thurs twice a week visit schedule. Normally I really prefer morning appointments – driving over in the car pool lane and coming back before rush hour is ideal. We were not that lucky this week – the earliest available appointment was 1100 with the follow-on at 1430. As you can imagine, by the time we finished it was 1700 which means we didn’t get home till close to 1900 (ok, discount 20 minutes for a grocery store stop, but still).

In recent years, most clinical and retail locations have put strict guidelines on costumes in the work place. Admittedly, if common sense doesn’t prevail, you really don’t want anything that is going to scatter pieces, expose an excessive amount of skin or scare really young children.

The oncology/heme-transplant clinic at UCSF only deals with adults, and children (short, disease carriers) are specifically prohibited. Those facts didn’t change the costume guidelines, but the staff still managed to have a lot of fun.

I didn’t manage to get a picture of the skeleton, the jailbird with a chainsaw, or Trump in the orange jumpsuit with ball and chain. Waldo missed the photo opportunity –

but was spotted later

where in the world

Migraine

Holly Doyne Posted on by 4
There is not much to talk about today. I never left Berkeley. For a short while I pretended that I was fine. But when I contemplated attempting to deal with a bus, traffic, people, etc I went ahead and acknowledged my limitations and took my meds and went back to bed.

George still had platelets in the double digits this morning, avoiding all need for transfusions. His docs are pleased. I may be able to spring him as early as Thurs. In any case, Will drive over in the morning so that I can pack up everything in preparation for heading home.

I can also bring along the supply of meds we have so as to prove to the pharmacy people that I am not kidding and have no intentions of repurchasing anything I already have on hand.

words in my head

Holly Doyne Posted on by 11
don’t do me anywhere near as much good as words on paper (which, in today’s world translates to words in an electronic document). I have come to acknowledge that putting off finishing the requirements for the two outstanding incompletes from grad school is not doing me any good. In fact, it more resembles the garbage left too long under the sink. The longer it sits, the more it smells. The more it smells, the less you want to deal with it. At some point, the nose is held (clothespin optional) and the stinking container is emptied, washed, and put back with all good intentions to avoid this cycle in the future.

Then the future rolls around again.

Please understand – I don’t give a flip about grades, all I want it is “met enough work to warrant a pass.” Having said that – it is hard to imagine putting in hours of work researching and writing for no good reason if the end results could possibly be of benefit.

It is the old Tikkun olam. Build the world a better place.

So… the background to today’s public health challenges include the following:

  1. San Francisco is an extremely expensive place to live
  2. The tech boom has resulted in an increase of 100k jobs over the last decade and the loss of 30k in housing in just the last few years
  3. The weather in California is not as bad as many of the other parts of the country
  4. changing demographics have resulted in marginalization of portions of the population.
  5. San Francisco became the mecca for a number of lifestyles starting in the 1960s

 

Now, back tracking to 2008-2009, there were several medical publications that discussed Hepatitis A infections and risks in homeless populations. Those discussions centered, of course due to the standard medical tunnel visions, on immunizing everyone to avoid disease.

So why was everyone in both city governments and public health circles so stunned when an epidemic of Hepatitis A started sweeping through homeless & IV drug user communities (and yes, there can be an overlap between the two). I fail to understand why anyone was surprised. Or, even more stunned to be in a situation where a normally mild disease most often seen in childhood in most of the developing world, various institutions was causing hospitalizations and death. This epidemic was recognized, not because of the obvious failure of the city, the infrastructure and public health to recognize the failure to provide for a vulnerable population but that hospitalization costs were skyrocketing.

The solution? According to the CDC – we should adopt the 2009 recommendations (hello, this is now 2017….) to add homelessness, IV drug use or MSM* to the list of peoples needing HepA immunization.

For those of you who don’t remember the history of Hepatitis A – this was the food/water borne version of hepatitis for which you (as a citizen of a developed country) received a large shot of gamma globulin in a major muscle group (usually gluteus maximus). 5cc is a significant volume, trust me. In 1995, the first versions of HepA vaccine became available. Every military member with a brain in his/her head was more than willing to get immunized. One shot with maybe a booster vs large/painful shot every 3-6 months while deployed? Other than the military, most of the other developed world citizens at risk of HepA were tourists indulging in street food while visiting developing countries. With the usual transmission being the fecal-oral route, it was obvious to everyone concerned that sanitation was as important to breaking the infection cycle as immunization.

We seem to have forgotten that bit of intelligence. It doesn’t matter if you immunize the whole world against a disease. That is one disease. As anyone who has every had noro-virus, salmonella food poisoning or one of the hundreds of other possibilities, the key to not getting diarrheal disease is availability of toilet facilities accompanied by strict adherence to hand washing. Which takes us to a city where there are no 24 hour public toilets, hand washing facilities are limited, no one wants homeless encampments, there is not enough shelter space for those who need it, and serious money is spent on a daily basis on power washing human excrement off the sidewalks.

Yes, we can immunize everyone. But it is not going to solve the sanitation issue.

I am making some basic assumptions. The first is that most people do not chose to be homeless. That they don’t set out to be vulnerable, dirty, and hungry. That, if they had the money to have food and shelter, they would. But San Francisco has teachers in their schools living in cars because they can’t afford a place to live.  I also make the assumption that mental health, substance abuse issues, and physical health issues impact lives to the point where many become homeless. And those problems don’t become better by being without a home.

<two hour break in which I spent digging through PubMed. Surprise, surprise, all the public health people, when discussing issues related to the HepA outbreak mentioned and repeatedly mentioned that sanitation was a serious issue and one of the most difficult to resolve. Having said that – it is no where in any of the CDC guidance. Just immunizations. Go figure>

I finished off the draft memo – sent it on its way, and spent sometime working on a Hitchhiker variation in a lovely yarn color called – magic unicorn.

 

*MSM= men who have sex with men…

 

Yogurt

Holly Doyne Posted on by 1
There are serious limits on George’s diet right now. Processed foods are fine, prepackaged complete with preservatives and fixatives. But nothing fresh, nothing from outside that doesn’t fit into the above categories, and certainly nothing home made.

UCSF runs an a la carte menu for patients. Rather than trying to come up with multiple daily menus, balanced meals and pap that no one would possibly want to eat – they actually treat patients as adults and let them order anything they are allowed to have off the menu. Up to six times a day. The only limits actually being the times of day that the kitchen is open.

But they have breakfast all day, soups, snacks, pizza and entrees after 1100. There are options from more than just the standard middle America fare, the ice cream (available in vanilla or chocolate) is Hagen Das, the vegan shake option smells horrible.

Last spring, the pudding option became one of George’s favorite and I had to find a local source for the first couple of months home before the novelty wore off. The yogurt wasn’t to his liking. A couple of days ago, I noticed that the Peet’s I have been stopping at on the way in morning carries smallish containers of his favorite brand of yogurt. It is prepared. It comes in a sealed container. He is allowed to have it, along with canned vanilla lattes.

It is a nice change from bananas, crackers, and peanut butter in single serving containers.

 

Strider

a sneakily simple knitting pattern from Martina Behm – takes one skein of sock yarn and is all garter stitch.

Strider