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.