I am sure that I forgot to mention that I received a call last Saturday from the San Bernardino SFVA call center. This lovely woman identified herself and asked if I would be interested in being scheduled for a COVID-19 shot at the SFVA.

Oh, duh. YES! and was scheduled for 0800 this morning.

I was up early for a conference originating out of Geneva. It turned out to be worth a lot less that the time involved so I was on the road with coffee from Peet’s in hand by 0630. Traffic wasn’t particular friendly going in as the marine layer (aka FOG) was blanketing the Bay Bridge, slowing everyone down to a crawl.

I finally managed to wend my way to the parking garage, get checked in through the outdoor screening process and hiked up the stairs to the first floor (the one above street level for those not familiar with the European norm of floor naming).

There were no signs. None. Not a one. I finally found someone at 0755 at the medical clinic who could point me in the correct direction. Not Building 200 – Building 1. And outside the auditorium for check in.

Ok, I can do that, arriving just as the clock rolled to 0800 and got in line. And waited, and waited. About 15 minutes later, one of the staff came out to apologize for the  delay, citing personnel turn over due to illness. Ok, if someone is sick, I really don’t want them administering shots.

As it turns out, the line was a mix of employees returning for shot #2, employees showing up for shot #1 and about 5% veterans mixed in just for good measure. The actual process went quickly, I hardly felt the needle going in. The immunization was recorded in both my electronic medical record and on a card placed in my hot little hand. As soon as my 15 minutes was up, I headed out the door, through the city and back across the Bay Bridge.

I even made a stop at Acme Bakery  as a reward for myself since there wasn’t a line.

By evening I had the expected sore arm.

Since most of them are not exactly sweet (the politicians, that is)…

And, as Pat reminds me (oh, it is sooo nice to have friends who are medical librarians…) ..

Except … that original marshmallow study? Was later shown to be flawed, badly. It turns out what it was actually testing was not executive function or self-indulgence, but social determinants/influencers of health. Kids who were raised in scarcity, poverty, with a lack of resources had learned to not trust adults who said they could have more later, and figured a bird in the hand is worth two in the bush. 

 

<https://www.theatlantic.com/family/archive/2018/06/marshmallow-test/561779/> 

 

Of course, that doesn’t mean that it still doesn’t apply to the situation. I wonder what would have happened if the study had continued on for a year, and the poor kids gradually learned they could trust the researchers, and the rich kids decided they were bored with waiting, their parents will buy all the marshmallows they want at home. 

Or, those with reasonable knowledge in science are able to figure out that ignoring the rules for five days is not going to improve their lives in the long run.

As one of the members of Island Knitters commented last night – “Is getting the family together this year important enough that you are willing to take the risk that some of them will be dead next year?”

It is not rich or poor in the case pretending the virus is also going to go on holiday … wait! The virus is going on holiday, but not as taking a break but happily going along to enjoy new locations, new groups of people, and overwhelming even more city, town, and rural health care systems.

There will be an excellent discussion today from UCSF Medical Grand Rounds at 1200 (PDT) on schools, vaccines distribution – link here. If you read this later, you can find the recording on YouTube under UCSF Grand Rounds.

Yes, we all need to make decisions on our own health and sanity. But also be aware that those decisions have far reaching ramifications on our families, our community, and our society affecting both those we know and individuals that we have never met.

Ok. Let us do some simple arithmetic.

According to Wiki (why not?) the current US population is 326.7 M. That actually seems reasonable to me. Or, I can use WorldoMeter which says 331M. Ok, that many people is not reasonable. it is way too many people for me to deal with. Admittedly, it is not China or India. But still – it is a lot of people.

Now let us move on to an agency which has really lost reputation in the last four year – the Centers for Disease Control (CDC) home base in Atlanta Georgia. They are looking at vaccine distribution. COVID-19 in case you had any question. I found the following which I am not going to paraphrase – just quote for you –

The overlap is significant in the four priority groups put forward by CDC. The CDC staff estimated that about 21 million people would fall into the healthcare personnel category, which includes hospital staff, pharmacists, and those working in long-term care facilities. There are about 87 million people in the essential workers groups. More than 100 million adults in the United States, such as those with diabetes and cancers, fall into the high-risk medical conditions group. Another 53 million people are aged 65 and older.

Now, think about it. I can do those numbers in my head, but still. If you agree with those numbers, you are saying that 261M of the 326M are in the priority groups (only adults are in the priority groups). If you look at the population pyramid of the US, you will note that there are at least 80M who are aged 19 or below. Kind of scary that – less than 1/4 of the US are children/adolescents. The percentages for children in Australia and Germany are about the same,  the UK slightly higher.

Which means that children (unless you are one, or have some close to you) are not particularly relevant to discussions being held. 

And I think we need to really stop, and think about these decisions in terms of society and the future. Given the priorities above – 3/4 of the US population is essentially in a Cat 1 -risk. Seriously? Perhaps (and yes, I would have to wait) we should first eliminate everyone in the first round of immunizations who can shelter in place. No, it isn’t fun. But I can do it, I can afford to do it. And someone else might not be able to. We need to include high risk children (and their parents) if we want to reduce risk, suffering, and burden on the health care system. We need to not include those who are not in direct contact with others (admin staff isn’t, cleaning staff is). 

I agree with Canada – children in school are critical. They are our future. Better that I, and those like me, be bored for another six months in favor of getting children and teachers back into the classroom.

But flinging around large numbers like those put out by the CDC, even with a caveat of “there is overlap” is irresponsible. It doesn’t educate, it doesn’t give anyone a sense that there are adults in charge. All it does is set up for “more excuses…”

off soap box.

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…