Immunology is Hard

Immunology is hard, people. I was a fantastic student right up until Immuno-Genetics, where my C- from Naomi Rosenberg was a passing gift. True story: I could not answer most of the questions, so turned the test over and word-vomited all of my memorized notes alongside an apology for being an idiot. Those of us who ultimately earned our PhD in Immunology specialized in small pockets of a gigantic field. For four years, I studied the effect of a single protein on the ability of white blood cells to travel through the body. One protein. But for four years, I also attended weekly lectures, dissertation presentations of fellow graduate students, conferences, journal clubs, and even shared an apartment with another immunologist. Nicole and I didn’t pour wine, we aliquotted. We also digested a lot of theories, factoids, terminology, and problem-solving mindsets from the geniuses that taught us. I defended my thesis over 20 years ago, and somatic hypermutation and cluster determinants have not been close to the tip of my tongue since then. But as SARS-CoV-2 began its course across the planet, it all came rushing back with one great truth: Immunology is hard, people.

I’ve never been hopeful for a COVID-19 vaccine. And after visiting the Facebook page of my own community after our state mandated flu vaccines for kids in childcare and schools… well, even if Fauci backed a vaccine for COVID-19 today, many would opt out, anyway. Why? Thoughtful people worry that a quickly produced vaccine might not be entirely effective or safe, and let’s be honest; most people prefer to avoid any shots at all. But instead of saying those things, it’s juicier click-bait to blame an unpopular President for seeding mistrust in our scientists. In any case, the upshot about a pandemic-squashing vaccine is first that it is unlikely to be developed soon, and second that it will be harder to attain herd immunity with it than anyone assumes.

An oft-repeated argument against acquiring a flu shot right now is, “Why would I overtax my immune system during a pandemic?” This causes immunologists to face-palm, but they’ll seldom chime in to correct this vein of thinking. Again, Immunology is hard, people. Also, anti-vaxxers of all varieties are especially combative in on-line settings and paradoxically immune to PubMed searchable corrections. But as an immunologist, it sounds like this to me: “Why would I get my oil changed when I need new brake pads?” Your immune system is diverse and complicated with myriad weapons; it can react and remember. It uses too many different cell types and mechanisms to recount here. Quite simply, though, a recently published systematic review showed that COVID-19 is associated with certain co-infections–Influenza types in particular, for which we have vaccines– that increase mortality in those patients. (Bacterial infections are also common in our sickest COVID-19 patients, but we have antibiotics to treat those.) We also want to keep preventable diseases to a minimum during a pandemic. My hunch is that a flu shot/mask-wearing combo will stifle a significant number of flu cases and hospitalizations. Yay!

But how do we get back to Life as We Knew It?

We’re back in Zoom School here at the Lee house, and it feels like March all over again. My boys log in with bedhead, want lots of different snacks and meals at different times, and are always around except when the puppy needs walking. Their school put together an incredibly thoughtful plan that puts boys on campus with their cohort every other week. With masks and Purell stations and extreme vigilance (I’m looking at you, sportos with your outta state tournaments) we might get the whole school back in person before lacrosse season. Unfortunately, the only tools we have right now are self-evaluation (which requires diligence and honesty), hand washing (ditto), masks, and social distancing (which we’re fudging a bit inside the schools).

What if we could just test ourselves every day before leaving the house?

The greatest minds in epidemiology and virology tell us the only way we’re going to stop SARS-CoV-2 from reappearing and spreading in hotspots for years to come is to battle the RT into submission by keeping people who are actively shedding virus—whether they display symptoms or not—from leaving their homes. Dr. Michael Mina has been a vocal expert and advocate for technology that already exists: a home administered saliva test that takes 15 minutes. No, it’s not as sensitive as the PCR assay that amplifies the actual viral genes. Instead, it detects a certain threshold of antigens: those sticky proteins on the outside of the virus. Your positive Rapid Antigen Test would mean you are COVID-19 positive and also suggest that you are extremely infectious. Of course, those who test positive with the home test would follow up with a PCR test and a doctor’s visit (more data, yay!), and those who test negative and have no symptoms could go to school, a restaurant, or the movies. There will be some gaps with false negative tests, but with daily testing the chances of missing positive cases are reduced each day (yay, math!). Also, there will be far fewer false positives than the PCR assay, which is likely keeping people quarantined longer than necessary.

Experts predict that we could get our pandemic under control in as little as six weeks with widespread, daily rapid antigen testing. Meanwhile, we could more confidently open schools and gyms, see people outside of our bubbles, and worry less about killing grandma. The only things stopping this is red tape, money (ok, so a heady sum of $), but ultimately… The American Spirit. Explaining the inexpensive ease of daily testing to my own smartypants big sister was met with, “meh… sounds like a lot.” Even when I explained that it could cost $1 and take 15 minutes, she, like so many of us, is just over it. We have a collective pandemic fatigue that is making us skeptical and more and more willing to turn a blind eye to the thousands (millions?) more who will die if we don’t do something.

Enter Dr. Scott Atlas. He’s likely brilliant and certainly has better credentials to speak about the pandemic than the average Twitter ALL CAPS hand-wringer, but he doesn’t have any more expertise in Virology and Immunology than the guy reading your MRI. Nonetheless, he caught the eye of our President who is looking for different solutions, even if they might not be better. If you do a quick search, you’ll find that Dr. Atlas is advocating “herd immunity” to spare the economy and advance his career. That’s the problem with the quick search and also the leading motto of this essay. Immunology is hard, people. I think he’s being largely misquoted, but his stance on masks is just irresponsible. Either way, NYT reporters (none is a scientist) attempted to malign him today by reporting that his theories about T cell mediated immunity are considered bunk by immunologists. They even sourced a TWITTER THREAD that includes peer-reviewed papers of immunologists hopefully speculating about a role for T cell memory. They need more data, but they certainly don’t think it’s bunk. How did they get this wrong? First, they only read the first tweet of the thread. Second, IMMUNOLOGY IS HARD, PEOPLE. Finally, those of us who consider ourselves any sort of scientist are horrified about any of this being politicized. And sourcing a Twitter thread as a scholarly reference? And misinterpreting it? Naomi Rosenberg is going to give this less than a C-.

Wash your hands, wear your mask, socially distance as much as possible, and be honest about your comings and goings. But if you want to get back to something akin to Life as We Knew It, text RAPID CONGRESS to 50409 to support the development of inexpensive saliva COVID-19 testing that can be done at home!

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IMMUNOLOGY IS HARD. This group detected SARS-CoV-2-reactive CD4+ T cells in 40%–60% of unexposed individuals, suggesting cross-reactive T cell recognition between circulating “common cold” coronaviruses and SARS-CoV-2. THIS IS GOOD NEWS!

Midsommar Update: cautiously optimistic… if you wear a mask

Let’s talk about COVID-19 again. I want to share just a few paragraphs to simplify recent, good data that might lessen your anxiety over rising cases, the paradoxically increasing opportunities to spread this largely untreatable virus, and looming school start dates. And if you read no further the upshot is this: wear a mask and avoid places and situations where large numbers of people are enclosed in spaces without them.

For those of us in and around Boston, the numbers are promising. The effective reproduction rate of COVID-19 is now under 1; and when the RT is under 1, the virus stops spreading. From a microbiological perspective, this makes no sense. COVID-19 has not mutated dramatically and we are nowhere near herd immunity making hosts for coronavirus harder to find. It’s simply our behavior that has led to this decrease. Every canceled concert, empty seat at Fenway, closed bar, masked wait staff at outdoor restaurants, and postponed graduation party helped. YOU helped. Good job, Massachusetts!

With the RT below 1, our essential workers at grocery stores, pet groomers, and fast food joints are also safer. But as we relax stay-at-home orders, we need to personalize our own risk assessment: if you contracted COVID-19, how likely is it to kill you? When I first wrote about the novel coronavirus, citing data from Wuhan, 15% of patients required hospital care and the infection fatality risk (IFR) was over 5%. This number was terrifying as the scale of the disease was taking shape. Conservative estimates of 40% of the population ultimately contracting this virus could have resulted in 7 million Americans dying. This is why Dr. Fauci was on TV every night. Three months later, scientists have more data and that number has dropped dramatically. A promising study group from the Diamond Princess cruise ship tested all 3711 passengers and staff, effectively capturing even the asymptomatic carriers, and estimated an IFR closer to 1. As testing improved and widened, other studies (albeit quickly calculated and not-yet-peer-reviewed) found IFRs hovering between 0.5 and 1. And even if we’re still underestimating this, it’s a far cry from 5.

You can see here and here how well Massachusetts is doing IFR-wise. Another heartening statistic is a death rate of zero (ZERO!) for patients under 19. Unfortunately, these statistics don’t suggest we can stop worrying about Grandma. A closely studied population in Geneva stratified the IFR by age and found that in a city with sufficient hospital capacity and excellent medical care, the risk for those over 65 years of age is still between 4 and 7%. Other articles you have probably already read suggest that many of those patients are also overweight, diabetic, hypertensive, immune-compromised, etc. The best way to protect our elderly and at-risk loved ones is to prevent them from getting COVID-19 at all.

How?

Odds are, you’re already doing this. Masks masks masks, limiting exposure, and close surveillance of your own health. Back in March when tests were sparse and we had only just stopped doing spin class, Sunday mass, choir rehearsals, and travel team sports, we had no idea who in our midst could be carrying and spreading COVID-19. Strict shut down was essential. Today, scientists are less worried about you contracting coronavirus from your play dates and take-out containers than from a “superspreader.” Pockets of new cases arise as people with no symptoms (or let’s face it, probably a little under the weather but ignoring it) and who aren’t wearing masks unwittingly attend activities that should still be verboten. An alarming example out of India is cautionary: after a wedding reception where over 350 guests were somehow allowed, nearly 100 townsfolk were infected. Though most of those who contracted the disease were asymptomatic and ultimately isolated, the 30-year-old groom who had exhibited all of the telltale COVID-19 symptoms died only two days after the ceremony. This devastating case illustrates the tragedy that ensues when a person with a high viral titer (the groom) is widely exposed (parties over 20 people) in an enclosed venue (reception hall) at exactly the wrong time (active infection with droplet-spewing symptoms).

The Indian wedding example is what is happening in areas that now need to reverse course and reinstate restrictions. As unmasked young people flocked to restaurants, bars, and parties, it took only one superspreader in their midst to undo three months of curve-flattening. Those who continue to hawk conspiracy theories and politicize mask usage will use new data to their advantage. Whoo-hooing revelers who contract the virus and don’t die (because they are young), will cause the IFRs to drop even lower. COVID-19 remains as deadly as it was in Wuhan in December, but will seem like it’s petering out.

It’s not.

So wasn’t this supposed to be an essay to alleviate your worries and bolster your confidence to send bored kids to camp and (please please please) back to school? Yes. Yes it is. The kids are alright, as the saying goes. And yesterday, Massachusetts posted its first day of zero (ZERO!) COVID-19 related fatalities. Unfortunately our at-risk population will need to remain vigilant until we have herd immunity (not happening any time soon) or a vaccine. I am loathe to give you my hunch about a vaccine, so let’s leave it at this: keep wearing masks and washing your hands, postpone parties, see friends outdoors… and maybe we’ll RT this thing to oblivion.

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If Captain Kirk can wear a mask (while supporting the local bookstore… swoon…), let’s boldly join him in doing so.

Front Yard Pursuits

Good morning, friends who still read blogs. I hardly get past headlines anymore. Everything in the news is so exhausting, traumatic, biased, unkind, sensational, and so rarely… fun. But Bernie and I have been giggling for weeks on this little tidbit that I share for you here.

Before Hero’s very routine, but upsetting (for all of the boys in the house) neutering surgery, Bernie and I were taking long morning walks with the puppy. Often we were also listening to Morning Prayer, which live-streams on Facebook from Church of the Redeemer at 9:30am. Honestly, 25-year-old Britt, who thought pet ownership was a huge drag and God a myth at best, would not recognize this woman nearly twice her age. In any case, we were getting close to the house where Hero always freaks out a little.

“Watch this. Hero always barks here. I think it’s the swing.”

Right on cue, our prancing puppy stopped in his tracks, lowered his tail, and started growling down the driveway. The swing was, as usual, empty and oscillating in the breeze, tethered to the same overhead branch we see every single day. I mused aloud to Bernie that I am convinced ghosts exist and that Hero sees them.

Bernie was chuckling.

“That is an odd swing.”

I hadn’t really considered it. I mean it isn’t a cute hanging bench or even a quaint tire… it’s just a swing. Bernie continued,

“I mean, it’s odd to have that in the front yard.”

Is outdoor swinging a backyard-only pursuit? I hadn’t thought of that. Hero was still straining at the leash, desperate again to check out the swinging ghost.

“Britt. The swing is for one person. And… IT HAS STIRRUPS.”

OMG. Every day I pass a house where Hero barks at a sex swing. My ghost theory was swiftly debunked, and ewww why is this interesting to the doggie. Do they actually use it? Do you think they got it on super sale and have no idea what it is? Was it a gag gift turned permanent lawn ornament to alarm, amuse, or annoy nosy neighbors? WHY IS IT IN THE FRONT YARD.

Naturally, we’ve been working Sex Swing into conversations for weeks, so I guess it was no surprise that Facebook is now offering Bernie ads for one.

“Look! Price isn’t bad…”

Not bad at all. Father’s Day is right around the corner, and our front yard is chock-full of sturdy branches.

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Couldn’t bring myself to put a picture of a sex swing here. But my suggested items from Amazon have now taken an interesting turn.

Pandemic with a Puppy: A Day in the Life of Lees

Brodie told me yesterday (in the 12:30 to 3pm window of interruptions) that he rejects the idea of a “new normal.” I get that. I want life as we knew it to return, too. And it will. Sort of, and eventually. And because, as Father Michael Dangelo reminds us twice daily and on Sundays that “this will pass,” I wanted to capture a typical pandemic day in the Life of Lees. Teenage boys are wrapping up a year of high school. Hero is still a puppy. Bernie is WFH. And I’m doing All of the Things. My guess is most of you (especially the mommas) could white-board a similar schedule.

8 – 9:30am Wake up, walk dog, make puppy breakfast, drink coffee, wake up boys (WHO SHOULD BE WAKING THEMSELVES UP), make them breakfast, drink more coffee

9:30 – 10:30am Listen to Morning Prayer while walking Hero all over the neighborhood

10:40am At least one boy wants 2nd breakfast

11:20am Snackish children emerge from rooms for lunch, but it’s too early for lunch for everyone but the puppy

Noon Quickly frying dumplings because now everyone is starving and school starts again in 20 min but we had sandwiches yesterday

12:30 – 3pm Interruptions for political commentary of the day from Brodie, chitchat with Bernie, query from shirtless Teddy about his “gains” from a slightly altered workout, conversations with various contractors/painters/vet all while trying to OMG ANSWER JUST ONE EMAIL

3:30pm Boys need differing snacks/protein shakes after workouts. Hero hangs out on the deck half-heartedly barking at golfers, other neighborhood dogs, turkeys, the wind, and ghosts. Bernie emerges from Zoom purgatory asking if it’s too early for cocktails. It is too early for cocktails.

4:30pm We have decided it is no longer too early for cocktails. We listen to Evening Prayer and walk Hero all over the neighborhood to give the ghosts a break so they don’t start planning retaliation hauntings.

5:30pm Start preparing dinner during which the boys wander in and out looking for pre-dinner snack offerings and play with Hero for maybe 3 minutes and 45 seconds even though this is the only time of day he really needs lots of attention and the only time I ask them to watch the PUPPY THEY WANTED

6pm Dinner is ready. Not everyone else is. They eat anyway, because they are constantly starving anyway and also are good like this and will sit down right away and eat up every last bite while making yummy sounds and I just adore them. Bernie sneaks Hero little morsels even though the puppy eats like the princely puppy he is and already had his supper.

7pm Hero has the “zoomies” and cannot decide if he should be inside or outside or doing crazy figure 8 races around the furniture, so he does all of these. More barking at ghosts.

8pm What day is it? If Thursday, Friday, or Saturday, we’ll probably continue cocktail hour. Scroll on demand channels for 27 minutes, realize neither of us wants to watch the same thing, so we watch something meh that is too girly, too violent, or puts both of us to sleep.

10pm Hero is a sleepy puppy and does the cutest slow walk to his crate. The tell tale puppy plop signals bedtime for everyone except teenage boys who suddenly appear for dessert.

11pm – ??? Teenage boys are doing Internet things that might be for school, but who are we kidding. Only the ghosts know.

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Hero, adorable… and also sees dead people… probably.

Summer Without Camp… by Steve Safran

What all of us need this summer is a place for the kids to go where they can play, swim, and just be outdoors with their friends. A place with a lake, a baseball diamond, goofy songs and goofier crafts, paths through ancient pines… a place of their own.

They need summer camps. For parents trapped with school-aged kids, the need is bordering on desperation this year. And like so many of the things that could make any of this more bearable, they’re closed.

“Out of an abundance of love for everyone in our camp community, we cannot compromise the safety of our campers, teens, and staff … ” was written in a Camp Tel Noar email. Disappointed parents who had hoped their children would be able to trade Zoom screens for canoes in a few weeks opened similar messages. Tel Noar is a New Hampshire institution: a 75 year-old camp I attended as a kid from 1977-1981. It, along with Camp Tevya and Camp Pembroke are part of the Cohen Foundation camps, all three of which have announced they will be closed. This will leave them in serious financial trouble.

Summer camps don’t generally have endowments. Tel Noar (translation from Hebrew: “Youth Hill”) shared that they already “spent $3 million in facility maintenance, repairs, staff salaries, insurance (and) utilities.” At the same time they’re breaking the news that camp is canceled, they need to ask for donations to make up the shortfall. But, let’s face it, only a super-generous donor is going to mail the full tuition while their kids stay home. It won’t happen. Like some small colleges, a few of our beloved camps won’t survive.

However, summer camps are historically resilient, possibly because they are managed by people who provide a yearly respite from the worries of the world. Cape Cod Sea Camps in Brewster, MA is nearly 100 years old. It has seen its share of world-changing events: “Cape Cod Sea Camps has provided a camping experience every summer since 1922 and have held camp through the Great Depression, World War II, the polio epidemic and numerous other global events.”

But this year, even their cabins will be empty.

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Waterfronts are usually the hub of the summer camp experience 

In the overall scheme of world events that include a rising death toll of a global pandemic, canceling a season of camp isn’t at the top of the headlines. But it is heartbreaking for the thousands of children for whom camp life is an escape from their own world worries. It’s also a rite of passage, often the first time a kid tastes freedom and learns how to steer that privilege. Camp is where time does funny things, where the days go on forever, but it all ends too fast.

I had the joy of returning to Camp Frank A. Day in East Brookfield, MA last summer to teach podcasting, and it transported me right back to my counselor days in the mid-’80s. Everything was the same: the boathouse, the waterfront, the cabins, the dining hall– it was eternal and ruggedly beautiful. Teenage counselors haven’t changed, either, happily sharing the camp gossip once they realized I was one of “them.” I made new friends. Never before did grilled cheese and tomato soup evoke so many memories. Is there such a thing as “camp sandwich griddle grease” they order in bulk?

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Stevie teaching budding podcasters last summer

For the summer of 2020, Camp Day faced the same agonizing decision as their colleagues. The staff and its board debated, looked at the current environment, acted with the caution of the day, and emailed its community: ” …that there is too much uncertainty surrounding COVID-19 for us to confidently operate a safe and high-quality residential camp this summer.”

I still have friends from summer camp, friendships forged 40 years ago as we shared bunk beds and bug bites for only eight weeks of a handful of summers. Think about that. I’ve had co-workers whose names were forgotten after years in the same offices, if I ever knew them at all. But camp is different. It’s intense. Your bunkmates are your brothers. And the girls? So many firsts all crammed into the time it takes a ChiaPet to mature.

The first time I asked a girl to dance was at Camp Tel Noar. (It was followed shortly by the first time a girl rejected my offer to dance). The first “date” I had was at camp. I was nine. We had a field trip to Canobie Park and I asked Ellen G. if she would go with me. She was very nice. About halfway through our time there, I lost our ticket. It was a harbinger of dates to come.

Camp builds independence and the kind of self-confidence that emboldens a nine year old to ask a girl on a date. College shouldn’t be the first time a kid is really away, feels the pangs of homesickness, and learns to overcome that. Over the years, I became a happier kid at home from spending a summer in the woods.

All of these rites of passage and moments of joy and firsts are on hold. Camps that weathered wars and economic collapse have been felled by a virus. The waterfront will be still. The baseball diamond will remain pristine. The bunks, the dining hall, and the lake will be as still as they are in January.

Sound taps.

See you in 2021. I hope.

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Stevie (far left in the shorty-shorts and Hawaiian shirt) and his bunk on his first tour as a counselor.

 

 

 

 

 

 

 

Killing Grandma

The children are beginning to break. Brodie is quoting from Joe Rogan podcasts and Teddy is suggesting we’re the last family on the block actually enforcing social distancing. They’re very tired of screens and…us. They are looking to adults for answers and assurances, and we don’t have them. With summer right around the corner, they fear this stunted life is going to drag on and on: a purgatory without restaurants or movies, spike ball or sleepovers. School is being overly optimistic (when they aren’t being completely cagey) and hints school in September. So if they’re going to be sharing desks and germs in the fall, why can’t they play videogames together in our basement now?

Friends, the because it could kill grandma argument has worn thin. The invincible teenager trope endures. We need a plan and real answers to the repeated question:

“When can friends come over?”

My kids have fantasized about having a “chicken pox party” emulating our own moms from the ‘70s who organized play dates with our spotty classmates so we would “get it over with.” They mused that if all teens purposely contract COVID-19 and become immune at least they could return to some sort of normalcy? In their fantasy no one gets particularly sick, goes to the hospital, dies, or inadvertently kills grandma. In this fantasy they’re also willing to sacrifice their friends with underlying conditions or other hidden and unknown risk factors. I guess. It’s just a fantasy where the invincible teenager trope is reality.

One of their friends is saving money to pay for his own antibody test, desperate for some proof that he should be allowed the free reign usually afforded high school seniors in the last marking period. The odds that any sort of tipping point of teens are antibody positive and immune are probably low; but then again, they were swapping pathogens freely until mid March and could have been asymptomatic. If we don’t test them, too, we won’t know. And because we don’t know, we’re acting out of the abundance of caution necessary in these unprecedented times—which they hear as “because I said so.”

So what do we do? Children sense hypocrisy and inconsistencies more keenly than my puppy hears the rustling of snack wrappers. Right now a reasonable person could ask why golf is allowed, but not tennis? As beaches and pools, restaurants and salons, summer camps and daycare centers open, it will get more and more difficult to justify why my kids cannot play NBA 2K on the same couch with their buddies.

SO WHAT DO WE DO?

As we move forward, we are going to need to be personally responsible for our own safety and for the havoc our kids might wreck on suppressing a second spike. Are you, or do you live with, someone who has risk factors that would predict a more severe or deadly course of COVID-19? You should probably continue to WFH if you can, limit grocery runs, hold off on social situations in confined spaces, and know if your kids are acting in less socially distant ways. If you feel like your nuclear family is at a lower risk, you might feel more comfortable getting that pedicure, braving the beach bar, or letting little Jenny’s friend sleep over. But a short week after we begin to do these things, a lot of us are going to get sick. And the ones who don’t know they’re sick–and are shedding virus all over the place– could easily be our kids.

Once we start doing normal things, we’re going to forget that the goal of social distancing was never to prevent us from contracting coronavirus at all… just not all at the same time. Basic psychology predicts that we’ll erroneously assign a lower risk of contagion among people we know. I mean, they’re our friends! No one has symptoms! But coronavirus is the honey badger of diseases: corona don’t care.

Parents are already allowing small, local quaran-teen groups, swear they are shielding them from the at-risk and elderlies, and trusting them to self-police a group with no assurances that it is COVID-19-free. Is this advisable? Low risk? Nope. And though it may be inevitable, the safety of this is pure fantasy. Also, though I love them deeply, teenagers lie all of the time. The children, and unfortunately permissive parents who let them share recycled air in rec rooms and basements, are going to push the boundaries of what is safe. Epidemiological models and tales of super-spreaders at clubs, cocktail parties, and churches predict that it only takes one asymptomatic carrier to kill grandma.

Even the strictest mandates won’t prevent everyone from contracting COVID-19: it’s too contagious. As those rules are lifted, it’s up to all of us to protect each other. Here’s what we’re suggesting for Summertime at the Lee House:

No hangouts inside. It is safer to meet up in the fresh air (on the deck, around a pool, in the backyard) where the likelihood of swapping spit droplets is minimal. Activities need to be limited to ones where they can stay 6 feet apart. Tennis? Yes. Spike ball? Riskier.

No car-pooling. If absolutely necessary, everyone is wearing a mask.

Chemo precautions. When I was in treatment, the kids had to change their clothes and wash their hands before they could see me. After (outside!) hangouts with their buddies, they need to decontaminate when they come indoors. Let’s be honest, teen boys need daily if not more frequent showers. They should also be carrying Purell in their pockets.

Honesty. This will be the tough one. Grandma & Pop Pop and A-Ma & A-Gong have been quarantining since early March and miss their grandsons. Right now we’d feel comfortable having them visit because the only place my kids have been is Zoom School. But if our boys aren’t honest with us about their own vigilance to social distancing and hygiene as opportunities arise, the elders cannot visit… not without risking killing grandma.

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My boys have already grown tired of me suggesting a walk on the beach as an activity… and it’s not even June. Good luck with your kids. xoxo

The Re-Opening

What day is it? It’s definitely Friday, but Day Fifty Something for Lees on Lockdown. At this point most of us are well past the biblical 40 days of temptation and testing, but I think we’re collectively doing all right. From my screens, I see people reaching out to help those struggling mentally, financially, and spiritually. Our Steps to Success fundraiser could only be held via email blasts and status updating, but somehow raised more money for low-income students than we thought possible. Those who know how are sewing masks; those that don’t are buying them and delivering. Free meals, sidewalk chalk encouragements, Teddy Bear hunts, crooning from city balconies, family dinners, and Lisa on YouTube. This is the good stuff.

I’ve let loose only two primal screams of rage that were mostly directed at teenage boys WHO HAVE ONLY ONE JOB SO GET OUT OF BED ALREADY OMG WHY ARE YOU ASLEEP, but otherwise we’re safe and home and healthy, if also drinking far too much. One night after salivating over episodes of Salt Fat Acid Heat, I looked at our sleepy puppy and suggested to Bernie that we call it a night. It was 9:30. NINE-THIRTY. We hadn’t even finished the Pinot Gris.

Like all of you, I feel like I should be accomplishing stuff with all of this time. In addition to actual work that needs doing (65 manuscripts in the queue), maybe I should be learning to knit? Shredding old tax returns? Teaching Hero useless tricks? Shaping my eyebrows? Something. Instead, this cartoon pretty much sums up every day:

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H/T to Tom Fraatz for posting this from @instachaaz

Zealot Sister lives in Georgia, so we’ve traded thoughts about the safety of doing the things their governor is letting them do. She has no plans for urgently overdue tattooing (wtf), but is going to brave the world and odds to attend to her grays and nails. Is that bonkers?

Probably not. Her county isn’t a hotbed of positive cases. But then again, they haven’t tested everyone, so who can say? With strict hygiene and mask compliance, could it be safe? Safe enough? Honestly, I don’t know. But we’re Americans and not typically great at rule-following when doing so feels like an affront to our personal liberty—or even just makes our glasses fog up. Really, we’re gonna be the worst at this re-opening thing.

Here’s what I do know: as the country starts allowing us to eat together and permanently ink each other–either in a stepwise sort of scientific way or as a recklessly impatient public experiment– my phone is going to blow up the same way it did when the WHO finally said “pandemic.” I’m happy to be your go-to non-practicing physician and immunologist, but at the beginning, I had more answers. Now, nothing seems certain. And as a scientist, when nothing seems certain, it is because we don’t have data.

The smartest people are offering models and recommendations that seem to change daily, but they are still guessing at how many of us have been exposed. The R naught, or coefficient of infectivity—essentially how contagious a virus is—was originally estimated between 2 and 3 for COVID-19. Newer data suggests it could be twice that. And if asymptomatic virus-shedders getting their gel tips and lowlights can infect 5-6 people, a second spike bigger than the first might be inevitable. An R naught over 5 also means we need to wait until over 85% of us have “beaten” coronavirus before we can spring the kids from Zoom School and back to square pizza Fridays in a brick and mortar way in the name of “herd immunity.”

Are we willing to risk the morbidity and mortality of thousands more to achieve this? Or should we suffer this no-end-in-sight life without dine-in restaurants, grandma hugs, or Sox games until a vaccine or miracle treatment is widely available? More importantly than when this ends is how.

Most of us are itching for sero-positive proof as a Get out of Jail Free Card to get back to a pre-COVID-19 existence, and a quick and widely available antibody test will give us a clearer picture of where we stand immunologically. But it won’t be the panacea we crave. Most if not all tests that have been authorized for use are only allowable through the Emergency Use Authorization (EUA) pathway. Doesn’t mean they are bad tests. They’re just tests that haven’t been… tested. And as a result there could be a significant number of false positives because coronaviruses are as common as, well, The Common Cold. There can also be a significant number of false negatives because your plasma cells pooped from combating COVID-19 have stopped making IgG because your memory B cells can always pump out antibody later, if needed.

Do you wanna know how these tests work? You can Google ELISA or trust me when I tell you that they slather a shmear of COVID-19 surface protein onto the bottom of a teeny plastic well and test if your blood is carrying antibodies that stick to it. Some identify IgM antibodies—the first ones your body uses to fight disease—suggesting a more recent response to an exposure. Others detect IgG antibodies—made by B cells that “learned” a bit more about the invader, and indicate a later or resolved infection. Some tests can detect both. But the antibody to the shmear doesn’t prove that they actually neutralize the COVID-19 you transferred from the grocery cart to your nose. The test doesn’t mean your antibodies are effective warriors, it just means they stick to the COVID-19 protein shmear.

What will an antibody test tell us and how can it shape our path forward? It will give scientists more data, but only as much as a stack of Polaroids from the table centerpieces will tell you about how great the wedding was. The IgG assay is only a snapshot. To wit, if we tested everybody right now, we’d likely find that far fewer than 85% of us have mounted an IgG immune response to COVID-19. Herd immunity is likely many months (and deaths) away. What is the power of your personal IgG positive test? Scientifically, not much other than proof that you were exposed. Also, your laminated IgG+ CoronaCardTM might not protect you from a newer, mutated version of the virus… and we have no idea if or when a COVID-20 will emerge.

SO WHAT CAN WE DO? I think the only way forward is to learn from countries that take personal hygiene (mask-wearing, hand-washing, forbidden handshaking and double kissing) seriously. We can dramatically reduce transmission if we maintain the 2-meter rule as much as possible, wear masks, and act like reasonable people in the midst of a pandemic. It won’t be forever… just until we have more data, a treatment, a vaccine, or herd immunity. As the country opens up, we’ll move about in different ways that protect others and ourselves, and I hope we’ll be patient and kind as everyone gets on board. Seven weeks ago I could meet you bare-faced at Starbucks, kiss you hello, catch a late movie, or watch the Celtics with thousands of fans. We’ll get there again. Just not tomorrow or because your governor said you can. Slowly, surely, with caution, common sense… and a mask.

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Buying these from Remy supports #Masks4Meals, providing food for caregivers at Mass General… and they’re wicked cute.

Day 14: I miss my girlfriends

The twin girls across the street love my puppy. Almost every time I round the corner to the front yard, one of them runs out the front door in PJs or calls from a second floor deck to yell, “Hi HERO!” Their SIP time includes homeschooling, so I’m not surprised they’re staring longingly out windows looking for any diversion at all. With great pride they told me (always a leash apart) that school math is super easy for them, then with gloomy faces reported that Russian math was going to start up again soon. At almost 10 they are bursting with chatter and stories. I’ve only gotten to know them over the past month of Hero-walking and quarantining, but they’re magnetic the way all girls are, times two. I love their driveway chalk pictures and, you know, just all of the… girl stuff.

With Bernie still in and out of the hospital, it’s #Flattenthecurve Day 14 for Lees with no in person contact with anyone at all except all of these boys, the dog included. I’ve never lamented not having daughters because most of my favorite people made them and let me borrow theirs. But now I’m stuck here with ever-hungry seat-lifters and I’ve become Monica:

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I’ve also become a bit Monica with the cleaning… 

I miss Women’s Bible Study: a weekly reset that just isn’t the same when we’re not in a circle on couches giggling and praying and sometimes crying together. (Bible Study is a full contact affair, emotionally and physically.) I miss coffee with girlfriends: a lifeline to sanity, a sounding board for complaints, a no-judgment zone to share successes and worries. I even miss chatting with moms on sidelines. OK, maybe like one or two of you. You know who you are. When I picture Life after COVID-19, it involves margaritas with The Stockton Women, a fierce collection of cousins who share Grandma Mid: the hilarious, loving, smoking and drinking matriarch who loved each one of us the best.

I also miss restaurants a ridiculous amount. Meal planning and preparation and clean up is now a three times a day thing–often at different times, plus snacks. I miss meals out where my only responsibility was ordering and eating. And take out isn’t the same. Those of you also rinsing plastic containers for the recycles and marrying leftovers into Tupperware are feeling me on this. IT IS NOT THE SAME.

Talking to the twins’ momma on my multiple daily Hero walks (always a leash apart), I recognize she has zero down time. She’s working while homeschooling and entertaining her almost 10 twins who still need her supervision for things like slime-making and movie-approving. Meanwhile, I’m here with a puppy and teenage boys who sleep until 2pm. What a waste of resources that I cannot invite the girls over to make cupcakes, let them watch unapproved Netflix specials, and try on silly formalwear from the back of my closet…

… girl stuff.

 

 

 

Coronavirus 101

Jason started feeling sick. Not “COVID-19 sick” he wrote, but definitely sick. Though his presenting symptoms were not the classic myalgia/sore throat/cough, I told him what I’m telling everybody:

Assume it’s COVID-19.

Don’t Panic, is the first and hardest instruction to follow. But yesterday Jason earned an A+ in Coronavirus 101: What To Do When You Get Sick During a Pandemic. Jason realized he did not need medical attention, and stayed home. Jason knew COVID-19 testing was not necessary because even if he tested positive, there are no medicines to treat coronavirus (though new ones are being tested in a controlled, scientific way)… so he stayed home. Also, Jason’s COVID-19 status wouldn’t alter his behavior because he was already self-isolating, by staying home.

Social media is bursting with criticism: “I went to/called the doctor with xyz symptoms and risky exposures, AND THEY REFUSED TO TEST ME.” Angry, scared, and looking for people to blame, test-seekers are also unwittingly lowering the confidence we need to have AND SHOULD HAVE in our front line medical staff. And while they are out in the world attempting to tap limited resources unnecessarily, they’re potentially spreading COVID-19 or other pathogens. I’m going to repeat this a million times:

COVID-19 TESTING IS NOT MEDICAL CARE.

And this:

If you aren’t sick enough to consult a doctor or need the ER, you need to stay home.

This is Day 8 for Lees on Lockdown. We’re not protecting ourselves so much as shielding other people. Bernie was in and out of the hospital until Monday, so we’re assuming all four of us have been exposed and could be shedding virus with no symptoms. Does this mean after 2 weeks of isolation we can start sneaking in short visits with people who promise they have been at home, where no one is symptomatic, and everyone promises to wash their hands?

No. Nope. Not yet. No.

The most common text message in my phone right now is asking how long will this go on. And friends, there are no answers for this. We only have mathematical models, daunting statistics, and sobering graphs from experts who predict a more immediate crisis before any possibility of returning to a world where there is lots of toilet paper. But China reported no new local cases yesterday, and I’m clinging to that. Can you envision a cascade of mini celebrations as each city in the US begins reporting 14 straight days with zero positive tests? We’ll get there.

If you stay home.

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This t-shirt exists, and I want it.

A message for young people: quit it, and stay home

Dear Young People,

If you don’t kill us with your refusal to adhere to social distancing, we’ll all be hen-pecked to death by your annoying insistence on meeting up with friends. So quit it, and stay home.

The messaging that COVID-19 is less lethal to your age group–which is true, thank God– is being translated by some in your age group as “we won’t get it,” which is really really really untrue. Instead, because you have already been everywhere (school and sports and Starbucks) and with everybody (ditto) you’re carrying a risk of having contracted COVID-19 that is not zero. People your age are also more likely to walk around shedding virus while having no symptoms at all.

Some of you have become armchair epidemiologists and are manufacturing relative risk estimates based on positive COVID-19 reports in your area. Whatever you are guessing, you’re wrong. We aren’t testing enough people to know what the community penetrance is. Even if you arrived at the hospital right now and with the classic presentation (body aches, fever, cough, and fatigue), they wouldn’t test you for COVID-19 unless you were sick enough to be admitted. And though very few of you will get that sick, some of you will. Instead, you’re more likely to infect 2-4 people (that’s the R naught) every time you insist on going over to Emma’s.

Also, I don’t care what Emma’s family is allowing. Social distancing means you stay home. And if you have to go out–and let’s be honest, you don’t– you stay 6 feet away from other people. We’re also not buying your “I’ll go to the grocery for you” or “just gonna run up to Panera for a sandwich.” Children, please.

On Wednesday, I gave a COVID-19 overview to high school seniors who told me they hadn’t gotten much more information than, “wash your hands.” On Wednesday, which was just 72 hours ago, they didn’t entirely believe me when I told them schools would be canceled by the next day. I showed them graphs that prove how contagious COVID-19 is, and said out loud what no one is telling you: some of your grandparents will die if we do not slow its spread. You know what those kids aren’t doing now? They aren’t asking to go over to Emma’s.

Things might get grim, but right now you have an opportunity to help save lives by doing something you already love to do: stay home and play with your phone. Make some TikToks. Learn how to skateboard or practice your three-pointer. And armed with science (R naught! Homeschooling done for the day!), you can be an ambassador for public health just by telling your friends you’re not meeting up with them at Shake Shack.

Tell them to quit it, and stay home.

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Remember summertime when you didn’t know who these guys were? They are the definition of VIRAL. Related: the Hype House needs to be shut down. #socialdistancing