Covid-19 The Risks - Know Them - Avoid Them

People are hoping and anticipating a return to some form of normalcy.  I have been reading and sourcing many opinions.  I found a well written colloquial article by Professor Erin Bromage. If you are about to venture out into the world with or without the permission of the 'experts' this may give you some guidance. A precautionary Waiver.  I  provide this as information only and not my recommendation to do so.

It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That's what's going to happen with a lockdown. 

 As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I've said before, if you don't solve the biology, the economy won't recover. 

 There are very few states that have demonstrated a sustained decline in numbers of new infections. Indeed, the majority are still increasing and reopening. As a simple example of the USA trend, when you take out the data from New York and just look at the rest of the USA, daily case numbers are increasing. Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained. 

So throughout most of the country we are going to add fuel to the viral fire by reopening. It's going to happen if I like it or not, so my goal here is to try to guide you away from situations of high risk. 

Where are people getting sick?   We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.   But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks.... are these places of concern? Well, not really. Let me explain.

In order to get infected you need to get exposed to an infectious dose of the virus; based on infectious dose studies with MERS and SARS, some estimate that as few as 1000 SARS-CoV2 viral particles are needed for an infection to take hold. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.

How much Virus is released into the environment?

 

A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk. 

 A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds. 

A cough at 6 meters (18 feet)

A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).

Speaking: increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose. 

If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.

 A breath: A single breath releases 50 - 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled. 

 Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus. We don't have a number for SARS-CoV2 yet, but we can use influenza as a guide. We know that a person infected with influenza releases about 3 - 20 virus RNA copies per minute of breathing. 

Remember the formula: Successful Infection = Exposure to Virus x Time. In other words if you have to go somewhere, do not linger.   Have a list for grocery shopping and plan your visit.  Do not  "window shop'.

Air filters may offer additional protection. Hospitals use them all the time, especially in the ER, ICU, and Operating Rooms.  Air Cleaning Technologies An Evidence-Based Analysis

How coronavirus attacks the entire body — damaging the brain, kidneys and more

Modes of transmission of virus causing COVID-19

 

COVID-19 Superspreader Events in 28 Countries: Critical Patterns and Lessons

Understanding Your COVID-19 Test Result

The Risks - Know Them - Avoid Them

Covid Restrictions rescinded in Riverside CA

Good morning, it is 8 AM  Saturday morning on the "Left Coast".  Our restrictions are being loosened, however we are all still wearing masks.  Personally I like it as it gives me a false sense of security, however it reminds me of how close we cam to an even worse disaster with far more deaths that we already have suffered.  It also should remind us it is not over by a long shot.  Numerous predictions about the long term outcome vary greatly from utter destruction of world economics, to it will rebound quickly.  The. stock market seems to have largely ignored the pandemic, after showing an initial decline.  Perhaps no one is working at the NYSE. (Was it determined to be non essential?). It makes a few very rich, and no longer reflects real value of a company.  Social media has more predictive value. The stock market is like a horse race, all bets are off, and chances are the odds are worse in the stock market, and better at the Kentucky Derby where there are less than 20 horses.  You have a far better chance of. picking a winner out of a field of twenty than hundreds of stocks. 

Nothing will be the same? Yes, it will

Where are we this morning?  

Riverside County officials vote to rescind all local coronavirus public health orders.    reported by the LA Times

 Woman wearing a MAGA hat (near exit sign)

With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered.

The Board of Supervisors voted to lift the closure of vocational and higher-education schools, end the restriction on golf courses, eliminate limitations on short-term lodging, and remove the requirements to wear face coverings and engage in social distancing.

Comments from the Supervisors.

Officials also voted for the use of face coverings to be “strongly recommended” by the county, instead of being mandated as Kaiser implemented last month. The use of masks is only a recommendation on the state level.

During the meeting, 5th District Supervisor Jeff Hewitt said that he didn’t feel he needed to wear a mask, citing conflicting evidence of its benefits, but that he would continue to do so if certain businesses require it.

Like his colleagues, 4th District Supervisor V. Manuel Perez, the board chair, called the guidelines unattainable and impossible for Riverside County and any other urban counties with large populations.

When 1st District Supervisor Kevin Jeffries said the county didn’t have the power to revoke Newsom’s orders, Hewitt countered: “The funny part is we do all the enforcement, so his power is powerless if you don’t enforce it.”

Sheriff Chad Bianco had said Tuesday that he would not be enforcing any of the county’s restrictions, which he believed to be unreasonable. During public comment on both days, many protesters voiced their support of him.

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Kaiser about potentially amending the mask requirement.

On Tuesday, Kaiser said his position hadn’t changed, and he credited the county’s lower-than-expected COVID-19 cases and deaths to the strict orders. (conflicting statistics from the Los Angeles Times) (see below)

"With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered. He was not available for comment Friday night, and it was not clear if his position had changed, though he apparently plans to sign the recission orders."

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Cameron Kaiser M.D., County Chief Public Health Officer, about potentially amending the mask requirement.

Comment from an octogenarian

A 78-year-old man, who spoke in support of rescission, agreed with Hewitt said that he wears a mask only when he’s around people who are afraid. “I’m not afraid.... People get old and they die.”

https://www.domesticpreparedness.com/journals/march-2020/

Scientists Say Llama Antibodies Could Be Key to Defeating COVID

Scientists Say Llama Antibodies Could Be Key to Defeating COVID

"This is one of the first antibodies known to neutralize SARS-CoV-2."

According to a new study by an international team of researchers, antibodies found in the blood of llamas were able to stave off coronavirus infections.

“This is one of the first antibodies known to neutralize SARS-CoV-2,” Jason McLellan, from the University of Texas at Austin and co-author of the study, said in a statement.

The researchers built on previous research from four years ago in which they found that the antibodies from a then 9-month-old llama named Winter were able to neutralize both SARS-CoV-1 and MERS-CoV viruses over six weeks.

Luckily, the antibodies from Winter — who’s now four years old — also staved off SARS-CoV-2, the virus that causes COVID-19. Winter is a 4-year-old chocolate-colored llama with spindly legs, ever-so-slightly askew ears and envy-inducing eyelashes. Some scientists hope she might be an important figure in the fight against the novel coronavirus.  “Vaccines have to be given a month or two before infection to provide protection,” McLellan said in the statement. “With antibody therapies, you’re directly giving somebody the protective antibodies and so, immediately after treatment, they should be protected.”

The Llama and the Nanobody

The molecule the team produced, and for which they obtained a structure, represents only the extracellular portion of the spike protein, but it is enough to elicit an immune response in people, and thus serve as a vaccine.

“The antibodies could also be used to treat somebody who is already sick to lessen the severity of the disease,” McLellan added.She is not a superpowered camelid. Winter was simply the lucky llama chosen by researchers in Belgium, where she lives, to participate in a series of virus studies involving both SARS and MERS. Finding that her antibodies staved off those infections, the scientists posited that those same antibodies could also neutralize the new virus that causes Covid-19. They were right, and published their results Tuesday in the journal Cell.

Surprisingly, this isn’t the first time llamas have been used in antibody research, as The New York Times reports. Llama antibodies have been used in work related to HIV and influenza, where they helped discover promising therapies.

This is a 3D atomic scale map, or molecular structure, of the 2019-nCoV spike protein. The protein takes on two different shapes, called conformations—one before it infects a host cell, and another during infection. This structure represents the protein before it infects a cell, called the prefusion conformation.

Thanks to the llamas’ antibodies’ small size, they can connect with different parts of the virus more easily.  “The antibodies could also be used to treat somebody who is already sick to lessen the severity of the disease,” McLellan added.

“The binding of this antibody to spike is able to prevent attachment and entry, which effectively neutralizes the virus,” Daniel Wrapp, Dartmouth Ph.D. candidate and co-author, explained in the statement.

Scientists are hopeful a treatment plan for the newly infected in the form of antibody therapies is particularly promising.

Scientists Say Llama Antibodies Could Be Key to Defeating COVID:

Emotional Well-Being During the COVID-19 Crisis for Health Care Provider...

Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic

Providing care to others during the COVID-19 pandemic can lead to stress, anxiety, fear, and other strong emotions. How you cope with these emotions can affect your well-being, the care you give to others while doing your job, and the well-being of the people you care about outside of work. During this pandemic, it is critical that you recognize what stress looks like, take steps to build your resilience and cope with stress, and know where to go if you need help.

Mechanisms in neurobiology which help physicians and caregivers to deal with covid-19 patients.

Recognize the symptoms of stress you may be experiencing.

1. Feeling irritation, anger, or denial
2. Feeling uncertain, nervous, or anxious
3. Feeling helpless or powerless
4. Lacking motivation
5. Feeling tired, overwhelmed, or burned out
6. Feeling sad or depressed
7. Having trouble sleeping
8. Having trouble concentrating

Tips to cope and enhance your resilience.

Communicate with your coworkers, supervisors, and employees about job stress.
Talk openly about how the pandemic is affecting your work.
Identify factors that cause stress and work together to identify solutions.
Ask about how to access mental health resources in your workplace.
Remind yourself that everyone is in an unusual situation with limited resources.
Identify and accept those things which you do not have control over.
Recognize that you are performing a crucial role in fighting this pandemic and that you are doing the best you can with the resources available.
Increase your sense of control by keeping a consistent daily routine when possible — ideally one that is similar to your schedule before the pandemic.
Try to get adequate sleep.
Make time to eat healthy meals.
Take breaks during your shift to rest, stretch, or check in with supportive colleagues, coworkers, friends and family.
When away from work, get exercise when you can. Spend time outdoors either being physically activity or relaxing. Do things you enjoy during non-work hours.
Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting and mentally exhausting, especially since you work with people directly affected by the virus.
If you feel you may be misusing alcohol or other drugs (including prescriptions), ask for help.
Engage in mindfulness techniques, such as breathing exercises and meditation.
If you are being treated for a mental health condition, continue with your treatment and talk to your provider if you experience new or worsening symptoms.

Stress and Coping

Stress during an infectious disease outbreak can include

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of alcohol, tobacco, or other drugs

Self assessment and inventory.

People who may respond more strongly to the stress of a crisis include

Older people and people with chronic diseases who are at higher risk for severe illness from COVID-19

Children and teens

People who are helping with the response to COVID-19, like doctors, other health care providers, and first responders

People who have mental health conditions including problems with substance use

Pre-existing conditions

High risk categories...age, chronic illness, emotional wellness

Note: Self assessment can be very difficult. Due to peer pressure, shaming and self esteem issues it is very easy to be in denial.  Ask for help when you feel overwhelmed and/or inadequate.  Others are experiencing these feelings as well. Sharing is caring.

Hopefully this post will help those on the front lines of the covid pandemic.

Please consult with a trusted professional before acting on information in this post.

Stay safe !

The Golden State Awakens

According to Guidelines from the CDC and Governor Gavin Newsom California will begin to stir on Friday from it's self-induced coma.   Restarting the economy will be a great challenge rivaling the shortage of PPE and ventilators.

Perhaps some background music will help us all

After weeks of waiting, some California businesses can reopen Friday. But it's complicated. Here are 5 things to know about the reopening.

California will move into the first new stage of its reopening plan at the end of this week, and some retail businesses will be allowed to open back up for customers as early as Friday — assuming they comply with new health guidelines, Gov. Gavin Newsom announced Monday.

The state has made enough progress in its efforts to contain, trace and test for the new coronavirus to allow retailers to reopen for curbside pickup, Newsom said. The businesses able to reopen this week include clothing stores, bookstores, music and toy stores, sporting goods stores and florists — which will be able to open in time for Mother's Day on Sunday, the governor pointed out.

Manufacturers and other logistics companies that make up retail supply chains will also be able to reopen, he said. On Thursday, the state will announce guidelines that the reopened businesses must follow to ensure social distancing. In the past, Newsom has said those requirements may include temperature checks at the door and fewer tables inside.

This step means that California is entering Stage 2 of its gradual, four-part reopening plan, which Newsom laid out last week. The timeline for moving into each stage will depend on the state's ability to ramp up testing for the coronavirus, begin widespread contact tracing of people who've tested positive, and protect vulnerable residents, Newsom said.

Here are five things to know about Monday's announcement: 

This graphic from the governor's office shows the metrics that officials will use to decide whether the state is ready to lift more restrictions. (Office of Gov. Gavin Newsom)

1) Some businesses can reopen.

The only businesses allowed to reopen Friday are "low-risk" retailers that can open for curbside pickup, to minimize person-to-person contact. This includes clothing stores, bookstores, music and toy stores, sporting goods stores and florists — which will be able to open in time for Mother's Day on Sunday

Manufacturers and other logistics companies that make up retail supply chains can also reopen, Newsom said.

2) Many more cannot.

Offices, shopping malls and dine-in restaurants will not be permitted to open this week, even though they were included in Stage 2 of the initial reopening plan.

Higher-risk venues like gyms, hair salons and churches, which include more person-to-person contact, won't reopen until the state enters Stage 3 of its plan.

And mass gathering places like concert venues and sports stadiums will stay closed until the state has access to drugs that treat COVID-19 — a development that may take months or longer.

3) Some counties can lift orders sooner. Others can keep theirs stricter.

Some California counties, which have seen relatively mild outbreaks of COVID-19, can now develop their own containment plans in which they lift restrictions sooner than the rest of the state, Newsom announced Monday.

These counties, some of which had already started defying the statewide order, can move further into Stage 2 by allowing restaurants and other hospitality venues to reopen. But the counties' plans must be certified by the local health officer and county supervisors, Newsom said.

On the other hand, regions like the Bay Area, which have stricter stay-home rules than the statewide order, are free to keep the stricter limits in place.

4) Stay-home orders could come back.

Reopening the state doesn't mean the virus will no longer be a threat. Hospitalizations have stabilized, and the state has expanded its health care capacity enough to treat a surge of patients, but people will keep getting sick until there's widespread access to a treatment for COVID-19.

That means stay-home orders could be reimposed if virus cases spike again, Newsom said Monday. Last month, he described this as a "toggling back and forth between more-restrictive and less-restrictive measures."

It's one of many reasons why life after the crisis will look much different than before. Restaurants will reopen but may have temperature checks at the door, along with fewer tables inside, officials have said. Face masks will likely remain common. And mass gatherings won't happen for the foreseeable future.

5) More testing and tracing are coming.

One reason for cautious optimism: state officials say they have ramped up their ability to trace and test for COVID-19 — two metrics considered among the most important for containing the disease.

California is now testing 30,000 people each day for the disease — exceeding its goal of 25,000 by the end of April, Newsom said Monday. It eventually hopes to test 80,000 people each day.

Meanwhile, the governor announced a new program that he said will train 3,000 tracers per week, adding to an existing workforce of more than 2,800 tracers who work in 22 counties across the state. The "academy," developed in partnership with UC San Francisco and UCLA, will open Wednesday and aims to eventually train at least 20,000 contact tracers.

As the state considers when to further lift restrictions, officials will keep an eye on a number of metrics, including the rate of COVID-19 hospitalizations, the availability of personal protective equipment for health workers, the health care system's ability to handle a surge in patients, and the ability to continue tracing and testing for the virus

The Harsh Future of American Cities - in the Covid-19 era

Reality Check 101

Life will never return to normal.  It's the 'new normal'. 

During the next year our life will change once again. Most evident will be the increased level of background noise and automobile traffic. It will be many years until we move forward to a new reality.

Significant attribution to Steve Levine


History has unfolded in waves of profound depths
followed by the relief of buoyant times, only for the depths to return
with unsentimental speed. The French Revolution and the Reign of Terror
gave way to Paris’ jolly Incroyables and Merveilleuses, young men and
women who dressed ostentatiously and had a cathartic frolic — for about
four years until Napoleon took power. After World War I and the pandemic
Spanish Flu, the Roaring ’20s carried Berlin, London, and New York into
a new age of hilarity. But then came the global Great Depression.The hope in U.S. cities is that Covid-19 and the economic downturn will end with another delirious release — a rash of buying by exultant consumers, a new economic boom, and a return to work.

But alongside the displays of liberation, and for years after, American
cities and towns seem likely to see untold scars of both the pandemic
and the depression-like recession.
On the nation’s current trajectory, one of the most probable post-Covid
future scenarios in our cities is stark austerity, with empty coffers
for the very services and qualities that make for an appealing urban
life — well-paying jobs, robust public transportation, concerts,
museums, good schools, varied restaurants, boutiques, well-swept
streets, and modern office space. There will be hopping pockets of the
old days with adjustments for pandemic safety, but for years, many
businesses could be shuttered and even boarded up, unable to weather
Covid-19 and the economic downturn. Joblessness will be high, and many
of the arts may go dark.

 American cities and towns seem likely to see profound scars of both the pandemic and the depression-like recession.

  

“In the Midwest, we have been pushing density — the rehabilitation of downtowns, smaller apartments in the core, the joy of being in a city,” Quinton Lucas, mayor of Kansas City, Missouri, said in an interview. “This completely arrests that development.” However, in this author's opinion small cities and rural areas may rebound. The longstanding effect of social distancing and isolation will contribute to a new form of socialization. Unaccustomed to quiet and solitude along with the sharp uptick of televideo conferencing and visual social groups, people will thrive. They will have learned the power of the internet, something our younger citizens (even boomers) already realize.

The 2010s started with a surge in city living, especially for millennials. They flocked to urban cores after the financial crash and injected them with vigor. But even before the coronavirus, the rush had tapped out. For the last couple of years, the top cities have been losing population, including New York, Los Angeles, and Chicago, according to Brookings. The exodus has struck even San Francisco County, the capital of Silicon Valley. Who has been leaving, and where have they been going? A lot has been the same millennials now a little older and taking up residence on the outskirts of smaller metropolises like suburban and exurban Atlanta, Dallas, and Denver, where new jobs and affordable homes can be found.

How COVID-19 will change the nation’s long-term economic trends, according to Brookings Metro scholars

     COVID-19 will transform the world, but changes might accelerate familiar trends

• Innovation and hybridization in food and retail will expand
• Low-wage workers are facing a housing crisis
• Will inequality increase among older Americans?   
• The pandemic crisis may also disproportionately impact:
• Low-income older adults who do not own their home outright
• Older Americans age 50 to 65 with no health insurance
• Older business owners in industries that were highly impacted in the pandemic
• Black and Latino or Hispanic older Americans
• Gen Z will affect how cities rebound from the COVID-19 pandemic
• COVID-19 will accelerate structural declines in microbusiness employment
• The country will finally address the digital divide
• 
  
  

The Harsh Future of American Cities - GEN:

When pandemics collide - HIV v. COVID19

Although many jurisdictions in the United States and other countries think it is time to wind down prevention,. the prevalence of Corona virus is endemic in many communities. Yes, that means the virus is still present, even though acute infections are diminishing. There is a worldwide pool of virus particles. 

The image above is. that of  Coronavirus

The image below is that of HIV

Although anatomically they appear very similar their pathophysiology is very different.  HIV attacks lymphocytes known as CD T cells.  Coronavirus attacks pulmonary tissues as well as other organs. It is not yet as well known the specific pathophysiology of Covid-19. Much more will be forthcoming in the next 6-12 months.

One pandemic virus has been a major topic in global health for almost 40 years, the other was discovered just 4 months ago, but, as SARS-CoV-2 infections have now been reported in most African countries, HIV and COVID-19 are on a collision course. Although we have learned a remarkable amount about SARS-CoV-2 in a short time, its potential impact on people living with HIV and on health systems in settings with high HIV burdens is becoming a major concern.

In Nigeria, as reported in a Feature by Paul Adepoju, the threat of SARS-CoV-2 is already having an effect on HIV and tuberculosis responses as patients choose to social distance by not going to health-care centers to collect drugs. Patients with tuberculosis in Ibadan have been reluctant to travel to collect drugs owing to the overlapping symptoms of tuberculosis and COVID-19. Indeed, clinical diagnosis of COVID-19 will be complicated by the high prevalence of tuberculosis, Pneumocystis pneumonia, and cryptococcosis associated with high burdens of HIV—all of which may have respiratory or imaging characteristics that overlap with the new disease. For care providers in the region, this will be a challenge not yet experienced in other settings.

The responses to COVID-19 in low-resource, high HIV burden settings will necessarily be different from those in the high-resource settings largely affected so far; but a history of adapting to diverse and shifting HIV epidemics in adverse conditions should enable creative solutions to SARs-CoV-2 across sub-Saharan Africa. As James Hargreaves and colleagues point out in their Comment, despite the differences between the viruses, the HIV response has lessons for the COVID-19 response.

One pandemic virus has been a major topic in global health for almost 40 years, the other was discovered just 4 months ago, but, as SARS-CoV-2 infections have now been reported in most African countries, HIV and COVID-19 are on a collision course. Although we have learned a remarkable amount about SARS-CoV-2 in a short time, its potential impact on people living with HIV and on health systems in settings with high HIV burdens is becoming a major concern.

Organizations including UNAIDS, UNICEF, and the International AIDS Society have begun to issue guidance and advice on how to deal with COVID-19 in high HIV burden settings. The Global Fund to Fight HIV, Tuberculosis and Malaria have also urged recipients to divert surplus funds to prepare and respond to COVID-19. We do know, however, that the response to SARS-CoV-2 is compromising HIV programs. As global travel and transport are disrupted, drug supply chains are jeopardized. In a Comment, Weiming Tang and colleagues highlight the contributions of non-governmental organisations stepping in to ensure consistency in HIV care during the SARS-CoV-2 pandemic.

At the time of writing, sub-Saharan Africa has reported relatively few cases: several thousand in South Africa and just tens or hundreds in other countries. However, these numbers are probably substantial underestimates owing to limited testing capacity. A unifying factor of the countries that have managed to suppress SARS-CoV-2 outbreaks rapidly is large-scale testing and contact tracing. Where those facilities are not possible, sentinel testing to identify the worst affected areas might be one solution to make the most of limited resources.

South Africa acted rapidly by imposing a lockdown, banning the sale of alcohol, and taking homeless people into facilities where they could be observed and where substance-use issues among the homeless can be managed. But social distancing is not always possible; many people in high HIV burden settings live in densely populated, cramped housing with limited access to sanitation. To help reduce transmission, Kenya has banned public gatherings, made the wearing of masks mandatory in public, imposed curfews, and set up isolation and quarantine centers for people who test positive for SARS-CoV-2 and their contacts, respectively.

Multimonth dispensing of antiretrovirals has been a topic of interest in recent years: in Kenya, South Africa, and elsewhere, provision of 3 months or even 6-month supplies of antiretrovirals at one time as a response to COVID-19 is becoming the norm to reduce clinical contacts and to facilitate social distancing.

WHAT PEOPLE LIVING WITH HIV NEED TO KNOW ABOUT HIV AND COVID-19

When pandemics collide - The Lancet HIV:

My Corona – Logging the symptoms of COVID day by day

Covid19 is not just another flu or flu-like illness. 

The story linked here from a blog by a patient who has Covid19, a. young healthy person without any pre-existing conditions.  He may have been lucky however it is still not over after several months.

I am very fortunate.  I am a retired physician who also has several serious heart conditions.  Suffice it to say I needed to have a cardiac pacemaker inserted several months ago.  I am much better now and did not realize how ill I had become until it became difficult to just get out of bed and go to the front door. Although I can function much better I know that if I get the 'virus' I would probably die. 

Most of you are younger, healthy, and feel immortal. Living in denial is common.  We all are in denial to think you cannot get covid19. What is more serious is that most people think it is over.  It is not.  Do not feel reassured when authorities (politicians) state it is safe to not shelter in place or forget about social distancing and/or sanitizing.

Officials in my neighborhood are talking about one or two more weeks of the strict program, and then gradually loosening restrictions. They say they are following scientific advice or protocols from public health authorities.  As a former physician, I tried to be as scientific as possible in my clinical decisions. My experience has been statistics are misleading.  If you are the one in a thousand who contracts covid19 statistics mean nothing.  The key is don't get it, don't gamble with your life and keep a cool head about finances and business decisions.

Be prepared....here is your list:

I realize I don't have to work and I am immune to financial pressure.  For others the decision is overwhelming, you may or may not have dependents, who you protect, a wife, and a home.  Material things can unduly influence critical and. sometimes life-saving decisions.

Others will say it is now safe to resume a normal life. You will read about a restaurant opening, with adjusted seating distances to ensure social isolation.  Today I walked to the supermarket..a foolish move since I have someone who could shop for me. I made an unwise decision to stop at the donut shop to satisfy my addiction to comfort food (a raisin cinnamon roll).  I rationalized it since I had not had the yummy carb-loaded dough, sticky frosting, and raisins. I saw several people without masks. I have a new name for "The Walking Dead".  I went home where I was greeted by my eldest son.  I knew what I had done. Shame on me. To make matters worse I have a son who has cystic fibrosis, a son who is a miracle of his own having lived to be over 30. years old thanks to breakthroughs in cystic fibrosis treatments.

Fascination breeds preparedness, and preparedness, survival. Peter Benchley – Author of Jaws

My eldest son brought me back to reality in a firm and kindly way.  My advanced years (78) and poor health suddenly made me know that my son was now wiser than I am. He was firm with me and told me if I did that again he would petition a court for him to become my guardian.  That got my attention.

Age and infirmity sneak up on all of us, and pandemics do not stop for age or stupidity.

Make up your own mind.  You know what is best for you and don't let anyone convince you it is safe to re-socialize. Especially a man who said we should drink bleach or spray Lysol in our mouth.

Listen to the guidelines, but wait and think about it.  It is far from over. Your employers are in worse shape than you financially, they want to save their business, you should want to save your life, and your family.

A story unfolds as told by a covid19 survivor

This virus is fickle. It makes is difficult to gauge what can be classified as a marked improvement. Symptoms come and go by the day. They worsen or improve in an instant. Recently, the days started to bifurcate......................

One group member asked, “If you can remember, what was your VERY FIRST symptom?” The results surprised me. Based on way more responses than I could bother counting, sore throat seemed to have been cited more frequently than fever or dry cough. This isn’t something I’ve read online or seen on television. This was one individual at a time saying what really happened to them...........

Essentially all of the members moved beyond thinking about testing for the virus. A big percentage of them never got tested for a variety of reasons (many like me on doctor’s advice) or tested negative but have displayed every symptom for a week or more — clearly some false negatives. A positive test would only seek to affirm what they already know. At this point, there is nothing they can do with the information that the test provides

Accurate antibody testing information is critical right now

She left them at the top of the steps and backed away. My five-year-old brought me a rainbow-striped egg, a clever frog with a bright red tongue that you can move, and a purple bunny with a fuzzy nose and googly eyes. “I’ll see you when the virus is gone and you can come downstairs. I love you. See you later.”

Every other sentence from her begins with ‘when the virus is gone, I’m going to…’. She’s not even sad about it. What a strange practical reality for a small child.

The virus isn’t going away this weekend and daddy won’t be coming downstairs, sweetheart. I know it is disappointing for her and my older daughter because they wanted to do ‘Easter things’ with me and of course, I wanted to do the same.

The doctor told me, not surprisingly, that I need to stay the course — rest, relax recover. And as always, if anything worrying progresses, don’t hesitate to call. The advice in the media is all over the shop regarding when you are safe to be around family again. His guidance was to wait until I’ve had three consecutive days of significant reduction in symptoms before I can join them..........

A friend recommended that I get a pulse oximeter

The illusive pulse oximeter

My wife is my rock and the people in my town are amazing. They have flooded her with texts, calls, emails, and anonymous care packages (please…I’m not fishing here) to help get through this......


Please stay safe and well.


“I have hardly anything in common with myself and should stand very quietly in a corner, content that I can breathe.” 
― Franz Kafka

Is it over?

What will it be?  Which side will you on?







My Corona – Logging the symptoms of COVID day by day: