“It only kills the old and sick.”

I’ve heard a lot of people, usually conservatives, say that if COVID only kills elderly or sick high-risk people at high rates, then everyone else shouldn’t have to follow any preventative measures. The high-risk people should be the only ones who have to isolate.

The whole idea is pretty ableist. It implies that the lives of the high-risk should be sacrificed for the convenience and financial prosperity of everybody else. “But that’s not it,” they say. “High-risk people can still quarantine and be perfectly safe. I just shouldn’t have to change my lifestyle for something that doesn’t threaten me.”

Okay, so let’s take that as a premise: All high-risk people need to be able to isolate, all low-risk people should be completely unrestricted. What does that look like in reality, if we truly value the lives of the high-risk population?

First of all, there are more high-risk people than you think. Elders, cancer survivors, anyone with diabetes, kidney disease, heart disease; anyone immunocompromised, anyone with severe asthma or lung disease. That’s about 10% of the population (and I’m not even counting the moderate-risk folks for whom COVID is still more deadly than the flu). Those people need to be able to stay at home, completely isolated, because everyone else is taking no precautions at all. Therefore, we need to provide them their salaries–remember, many of them are working and they can no longer work outside the home–as well as make sure their medical needs are cared for safely. We also need to deliver their groceries and other home necessities. They will need to be given legal assurance that their jobs will be there for them when they leave isolation, and that they will not have their utilities cut or be evicted.

For various reasons, many of the high-risk cannot stay entirely alone. They live in nursing homes or prisons; they need home health care workers; they need regular doctors’ visits; some are children living with families. These doctors and home health care workers are now making house calls, since the people going for normal checkups are taking no precautions. To keep the high-risk safe, all doctors, home-health care workers, prison staff, and nursing home staff will also need to isolate completely. They will need the same precautions and support as a high-risk person. Also, they will not be able to interact with low-risk people taking no precautions. That means that doctors will now need to be divided up between those seeing high-risk patients (and isolating) and those seeing low-risk patients. You are likely to need to change doctors.

Let’s break up a few families while we’re at it. Any high-risk people, medical, or residential center staff living with family have a choice: Their entire families can go into isolation (as above: No working outside the home, no going into public spaces whatsoever), or they can find an apartment outside their home, move out, and isolate there, or move to specially designated hotels, where all of the residents are isolated. All of the hotel staff will have to isolate, too, of course. All those who work in a prison, nursing home, or as a home-health care worker, won’t see their families until herd immunity unless their families isolate totally with them. And they’ll need most of the same services: Grocery delivery, high-risk medical care, and free rent or hotel bill.

Of course, after the pandemic ends, everybody who has been in isolation will need help getting back to work. They’ll need financial assistance not just until herd immunity, but until they’re able to find another job or return to their old one. Some may never be able to return, since younger people have simply taken their positions; so we had better make sure they don’t starve.

Now, if you don’t want to do this set-up, that’s fine. But it’s the only way to protect high-risk people while allowing low-risk people to take no precautions whatsoever. If you don’t support it, though, either admit that everybody has to take precautions, or admit that you don’t think high-risk people’s lives are worth inconvenience and lowered profits.

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You’re not “the only one” doing the right thing: A Mathematical Perspective

No, not hard math. Just counting. Don’t worry, math-haters.

Anyway, I recently realized this–and it should have been obvious, but I’m a bit slow on the uptake sometimes:

You know how you go out to pick up your groceries, or you scroll down social media, and it seems like you’re the only one wearing a mask, refusing to go into large crowds, staying home, etc.? Like everybody else is going out, ignoring all common sense, giving up on their grandparents and everybody else’s, and you’re all alone? Discouraging, right?

Well… it only looks like that. It can look like most people aren’t staying home even if the majority of people are, like you, staying home and wearing masks and being sensible.

Think about a group of 100 people. Let’s say 80 of those people are being smart, staying home, and going out to shop or go to the doctor’s or meet someone outdoors and distanced, about once a month. But 20 of those people are the plague-spreaders, and they happily go without masks. They visit public venues about every other day, just like they did before the pandemic.

The reality: 80% of people in this population are following COVID-prevention guidelines.

So every month, you have 80 people going out once each, and 20 people going out 15 times apiece.

You go out to the store, masked up; or you walk down the sidewalk. You look at the other people who are also out. This month, 80 of those trips outside the home will be from the wise people, and (20*15) 300 will be from foolish people.

It looks like only about a quarter of the population is being smart, like you are. But that’s not true. The foolish people are the minority. But they’re simply more visible. They go out more, so you’re much more likely to see them.

What it looks like: Only 21% of the people in a particular public space are following COVID-prevention guidelines… even though 80% of the population is doing so.

And that’s why, even if most people are staying home, it can look like practically nobody is.

You are not alone.

Oh, and I totally sneaked in some multiplication there. Muahaha….

Solitude

I’m plodding down the sidewalk. It’s trying to rain, but not quite succeeding. I’m wearing a coat, hat, mask, and sunglasses. The mask isn’t strictly necessary; my neighborhood isn’t crowded, especially in the middle of the day; but I’ve found that it keeps my nose warm. Besides, if people see me wearing a mask, hopefully it’ll become more normal.

My neighborhood is at that awkward age long after “new”, but long before “historic”. The houses are small, 1950s, identical. Window, door, window, window. A copy-paste suburb.

Every house has a fence. They are fence people, dog people, privacy people. I make a point of waving to everyone I see: Half-turn, hand up, wave once, wave twice, “Hi, neighbor!”, no need to smile because of the mask, but it’s implied. I’m used to greeting people I don’t recognize; I’m faceblind, so, out of context, I only recognize my closest friends and family anyway. And maybe, if I greet people, it will become more normal, and we’ll become more able to say, “Hey, can I help?” or, “Hey, can you help?”

I walk every day when I’m not too tired and I manage to kick myself out the door, which means I walk about three days a week. It’s a mile around my neighborhood. I figure that if I can make it in fifteen minutes without feeling tired, I’ll stay in shape for when I return to the library, when we are all vaccinated and I can finally volunteer again. You might not think library work is physically tiring, but that is not an opinion held by anyone who has ever carried seventeen books while dodging toddlers and looking for the large-print biography of Beatrice Potter requested by a patron who surprised them while they were trying to keep the cookbooks from invading and conquering the diet-and-nutrition section.

These are also flag people, so there’s a flag every few houses. Americans are entirely too much in love with their flags. The Biden yard signs were all taken down long ago, but increasingly sad-looking Trump signs still stick out of lawns here and there. One house flies an American flag printed with an image of Trump sporting Photoshopped muscles, holding an assault rifle, explosions in the background. Another flies a black-and-white flag with one blue stripe, meant to support the police. I wonder if they realize they’re not supposed to modify the flag. Or, for that matter, fly a tattered flag in the rain, which some of them are also doing. Not that this is illegal, nor should it be; but it’s considered awfully disrespectful. Well, I’m not a natural-born citizen, only naturalized; what do I know?

When I return home, it’s to the sleepy blinks of my cat Christy, who has lately reclaimed her territory from foster cat Katniss, adopted out last week to a middle-aged woman who wanted some company. Katniss is the last cat I will foster for CACHS, because CACHS lost funding this year. We used to have a no-kill county shelter with full service for feral cats. Come January 1, we’ll have only a dogcatcher. Another casualty of COVID.

These days, I’m alone most of the time, but it’s okay. People used to tell me that if you stayed alone too long, you’d go insane. I always thought I must be an exception, but I had no way of proving it because the world kept forcing me to socialize. Turns out I was right. I’m happy enough with my cat, my books, my computer, my work on zooniverse.org and my work on the disability memorial web sites, and the crocheted blankets I’m making for donation. I strongly suspect that solitary confinement isn’t torture in and of itself–it’s the lack of stimulation, the lack of things to do and think about, that people find impossible to cope with.

But this is a socially-focused world. People have been told for a very long time that they can’t live without socializing and, for that matter, can’t live without romance or sex. Maybe that’s part of why so many people in my country are ignoring safety regulations during the pandemic; they feel like it’s unconscionable to deny them their bars and parties because they don’t understand that solitude is perfectly possible. Not that I envy the extroverts right now–but it’s perfectly possible to socialize online. I know that an introvert like me will never quite understand what it’s like, but it can’t be impossible. I miss my library; I wish I could go there. I used to go twice a week. Can’t they stay home, just a little longer? People are dying. Where is their compassion?

But in the end I can only control my own actions, which means feeling a little bit at loose ends, missing the library, but in general, doing okay. At least I can refuse to be part of the problem.

How to deal with nightmares

I’ve read a lot of stuff from people who are having nightmares for the first time due to COVID. Things like forgetting your mask, getting sick, seeing family get sick, etc.

All right, y’all. I’m a veteran nightmare survivor–diagnosed PTSD and everything. Here’s some tips.

First of all: Don’t get mad at yourself for having nightmares. You can’t help the emotions they bring up. When you’re asleep, you’re not thinking rationally, and your emotions are going to run away with you. When you wake up from a nightmare, the best way to deal is to roll your eyes, go, “Well, brain, that was silly,” and remind yourself that you are safe.

Don’t assume that you’re doing something wrong if you have nightmares–you’re not. The vast majority of people who can remember their dreams remember nightmares at least every now and then. Even in PTSD, nightmares are a sign that your brain’s trying to recover, however stuck you may be.

Nightmares come from your brain trying to process stress, or trying to prepare you for possible bad situations you may find yourself in. The first one is necessary so you can defrag your brain from all the thinking you’ve been doing all day; the second one is an evolutionary advantage that helps us practice how to run away from saber-toothed tigers without actually having to deal with any large prehistoric felines.

If you’re any good at lucid dreaming, you can use it to help combat nightmares. If you’re having repetitive ones, look at what they have in common–the dead giveaways that you’re dreaming, not awake–and remind yourself regularly of those signs. For me, for example, a dead giveaway that I’m dreaming is that I’m in my mom’s house and can’t find a way out. For you, it might be “If I’ve forgotten my mask, I must be dreaming.” Because we simply don’t forget our masks nowadays, any more than we forget our shoes. If you manage to realize you’re dreaming while you’re still dreaming, you can just walk away from the whole thing; or you can fight it. Like, I might tell my dream mother, “I’m thirty-seven years old and I live on my own now. I don’t live with you. This is only a dream.” Sure, it’s silly to talk to a figment of my own imagination, but dreams are silly. Let them be silly.

If you wake up from a dream and you’re really on edge–like, heart beating fast, sweating, etc.–that’s probably because your fight-or-flight system got mistakenly activated during the night. Learn some basic calming techniques–breathing, relaxation, that kind of thing. Do those, and your body will start to calm down again. It does take a little while for the adrenaline to wear off, so you will probably have to wait a little while before you can go back to sleep; but at least you can do it in your warm, comfortable bed. Going to the toilet or getting a couple of sips of water can help too, but if you don’t have to get up, don’t, since it’ll make you less sleepy.

You know that old saying “the only thing we have to fear is fear itself”? With nightmares, that’s true. Some people get insomnia when they have regular nightmares because they hate the nightmares so much that they can’t get to sleep. It helps if you see nightmares as annoying, see the fear as an accidental jolt of adrenaline. They’re not a real threat–they are just your brain glitching out a little bit trying to process the stress and frustration of the day. Let it glitch, then go back to sleep.

And don’t feel guilty if these don’t work for you immediately, either. Sometimes it takes practice. I haven’t managed to banish my nightmares entirely, and I’ve been free and safe for nineteen years now. But I’ve sure as heck gotten better at going back to sleep afterwards and at getting a decent night’s rest anyway. Sometimes I even realize they’re nightmares, ignore my mom, phase through the walls, and go flying.

To a Newly Diagnosed Autistic Teenager

I was recently asked by a 14-year-old who had just been diagnosed autistic what advice I had to give. This is what I said.

The thing that helped me most was understanding myself and talking to other autistic people, so you’re already well on that road.

The more you learn about yourself, the more you learn about how you *learn*… meaning that you can become better at teaching yourself to communicate with neurotypicals.

Remember though: The goal is to communicate. Blending in is secondary, or even irrelevant, depending on your priorities. If you can get your ideas from your brain to theirs, and understand what they’re saying, and live in the world peacefully without hurting anyone and without putting yourself in danger, then it does not matter how different you are or how differently you do things.

Autistic is not better and not worse than neurotypical; it’s simply different. Having a disability is a normal part of human life; it’s nothing to be proud of and nothing to be ashamed of. Disability doesn’t stop you from being talented or from becoming unusually skilled, especially with practice. Being different means that you see things from a different perspective, which means that as you grow and gain experience you will be able to provide solutions to problems that other people simply don’t see, to contribute skills that most people don’t have.

Learn to advocate for yourself. If you have an IEP, go to the meetings and ask questions about what help is available and what problems you have. When you are mistreated, go to someone you trust and ask for help; and if you can’t get help, protect yourself as best you can. Learn to stand up for yourself, to keep other people from taking advantage of you. Also learn to help other people stay safe.

Your best social connections now will be anyone who treats you with kindness. You can tell whether someone is kind by observing how they treat those they have power over when nobody, or nobody with much influence, is watching. You want people who are honest, or who only lie when they are trying to protect others’ feelings. Talk to these people; explain that you are not very good with social things and that you sometimes embarrass yourself or accidentally insult people, and that you would like them to tell you when you are doing something clumsy, offensive, confusing, or cringeworthy. Explain to these people that you would prefer to know about mistakes you are making, because if you are not told you will never be able to correct those mistakes.

Learn to apologize, and learn that an apology simply means, “I recognize I have made a mistake and shall work to correct it in the future.” An apology is not a sign of failure or an admission of inferiority. Sometimes an apology can even mean, “I have made a mistake that I could not control; if I had been able to control it, I would not have made the mistake.” Therefore, it is okay to apologize if you have simply made an honest mistake. The best apology includes an explanation of how you will fix your mistake or what you will change to keep it from happening in the future.

Learn not to apologize when you have done nothing wrong. Do not apologize for being different, for standing up for yourself or for other people, or for having an opinion others disagree with. You do not need to justify your existence. You should never give in to the pressure to say, “I am autistic, but that’s okay because I have this skill and that talent.” The correct statement is, “I am autistic, and that is okay.” You don’t need to do anything to be valuable. You just need to be human.

If someone uses you to fulfill their own desires but doesn’t give things back in return; if someone doesn’t care about your needs when you tell them; if someone can tell you are hurt and doesn’t care; then that is a person you cannot trust.

In general, you can expect your teen years to be harder than your young-adult years. As you grow and gain experience, you’ll gain skills and you’ll gather a library of techniques to help you navigate the social and sensory world, to help you deal with your emotions and with your relationships. You will never be perfect–but then, nobody is. What you’re aiming for is useful, functional skills, in whatever form they take, whether they are the typical way of doing things or not. As the saying goes: If it looks stupid but it works, it isn’t stupid.

Keep trying. Take good care of yourself. When you are tired, rest. Learn to push yourself to your limits, but not beyond; and learn where those limits are. When you are tired from something that would not tire a neurotypical, be unashamed about your need for down time. Learn to say “no” when you don’t want something, and learn to say “yes” when you want something but you are a little bit intimidated by it because it is new or complicated or unpredictable. Learn to accept failure and learn from it. Help others. Make your world better. Make your own way. Grow. Live.

You’ll be okay.

Obesity, COVID, and Statistical Observations

I have been watching some YouTube videos from doctors and scientists reviewing the latest research on COVID-19, and when they talk about the effect of comorbidities on disease severity and mortality in COVID-19, they often mention obesity. They do not seem entirely aware of the obesity rates in the US, and how they might affect the interpretation of studies done in the United States.

In the United States, 42.4% of all adults are obese (https://www.cdc.gov/obesity/index.html). Among a sample of people hospitalized for COVID in New York City, 41.7% were obese. These sorts of numbers are often cited as as a reason to think that obesity may be associated with more severe disease (requiring hospitalization), but notice the base rate: If people hospitalized for COVID have roughly the same level of obesity as people in general in the USA, then those numbers do not support the idea that obesity alone is a risk factor for severe disease in the US population.

This does not hold true for severe (morbid) obesity: The base rate for that is 9.2% in the USA, but the proportion of hospitalized COVID patients with severe obesity was 18%. (This was before controlling for comorbidities, which people with severe obesity usually have; the chicken-and-egg problem of whether they are fat because they are unhealthy, or unhealthy because they are fat, is something medicine is still working on.)

This implies that the number of obese, but not morbidly obese, people in the sample of those hospitalized for COVID should be 23.7%, compared to the 33.2% of mild-to-moderate obesity in the general population. If this difference is significant, as it should be with a sample of over five thousand, that actually supports the idea that obesity could be a protective factor, while morbid obesity is still a risk factor. (However: The paper did not address this idea, and I do not know if the difference is statistically significant; also, I do not have the obesity data for New York City and do not know if it is different from that of the general population.)

It might seem like a quirk of the data, but I think it is very important for us to notice, because if people in the overweight/obese range are worried about COVID and go on severe diets to try to lose weight and protect themselves, the low calorie intake may cause their bodies to slow their metabolisms, which it will do partly by reducing their immune response. People on severe diets may in fact become less resistant to the coronavirus because they are trying to lose weight.

A very gradual diet is probably still safe, but I have not studied what level of calorie restriction, in the absence of micronutrient deficiency, is likely to cause immunosuppression. Unless the goal of weight loss is to cure or better control some comorbidity that is associated with higher COVID death rates, it seems that until we know more, the best approach for many overweight and obese people is that of moderation and common sense: A varied, healthful diet without calorie restriction, combined with sunshine and exercise.

Reference:
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775

Uphill. Both ways. You kids got it easy.

I’m stranded at home, because I can’t go out. I can’t work. To survive, I fill out paperwork for the government, proving that I need food and shelter, constantly facing the default assumption that I am trying to cheat the system.

I look at the rest of the world, people who say they are going crazy because they can’t leave their homes, who are enraged and frustrated because they are having trouble with the unemployment office, because they’ve waited a week or two weeks to get benefits.

And I think: Well, now they know what it’s like. Because unlike the people who have been dealing with this for a month or two, this has been my reality for fifteen years now. I waited for six months for benefits. Many people wait two years. Driving is not possible for me, nor is public transportation readily available. The way people live in isolation now, short on money and housebound, is the way my life has been for over a decade.

I’m disabled, and that means I’m a second-class citizen. The world takes it for granted that I have to live like this. And, however much I wish I could wipe this virus from the face of the earth so it would never make anyone sad, scared, or lonely again, I find it vaguely satisfying to have people finally acknowledge that the way I have had to live is lonely, unjust, and frustrating.

Don’t get me wrong; I don’t hate my life, or even my disability. I find happiness and I’m satisfied. But there are annoying things in my life that nobody seems to recognize as annoying, that people seem to take for granted as being part of the experience of having a disability and thus unchangeable. But they are not unchangeable. They come from society being too inflexible to include us the way it should. When people are upset about the things I have had to deal with for years, that tells me that those things really are as unacceptable as I say they are, even if, normally, nobody seems to think so.

Worried about India

I live in the United States, where things are getting pretty bad. But I keep thinking about India.

When I was a college student, I had Indian classmates–international students. They were the ones you could always count on to do their part in a group project; they were the ones setting the curve. Once you got past their accents, they were just as nice and personable as anybody else. And they had a passion for learning. I guess it stands to reason that if you are willing to go to a whole different country to go to college, you would have to be somebody who really cares about learning.

Now I can’t stop thinking about them–the laughing fellow who could make magic with circuit diagrams, the tiny short girl who’s probably a top-notch medical resident by now judging by how well she could explain anything in anatomy. I graduated years ago, so they must be home now.

I keep hearing about how India has a shortage of doctors, India has a shortage of hospitals, India has huge areas where you have to travel for ages to get medical care. About how they’re crowded in the cities, and isolated in the countryside, and have so many languages that sometimes it’s hard for doctors to even communicate with patients. They love technology, they love science, but they’re just getting started putting it in place. There are lots of places where you can’t even get Internet.

And here I am, in the United States, looking at New York City on the news and seeing Mumbai or New Delhi, and I just… feel so helpless.

I know none of you can do anything about it, any more than I can, but you’re good listeners. So thanks for listening. And if any of you are in India, please take care of yourselves and stay healthy.

Masks 101

As you may know, the CDC recently recommended that, to slow the spread of coronavirus, people should wear masks–even cloth masks–when in public.

So here’s what you need to know.

Types of masks:

N95 respirators can protect you from breathing in the virus. They are only worn by hospital employees because they are scarce and need to go to the people who need them most.

Surgical masks will not protect you from breathing in the virus, but they will protect others from any virus that you may breathe out.

Cloth masks–homemade masks, bandanas, and other makeshift alternatives–also cannot protect you from breathing in the virus; but they will protect others around you nearly as well as a surgical mask can.

But I’m not sick. I don’t need to wear a mask.

This coronavirus plays a nasty trick: It will spread even if you don’t have symptoms. Some people, especially young, strong people, never have symptoms at all. Other people will spread the virus before they feel sick. Because we can’t know if we have the virus, it’s smart to wear a mask whether we feel sick or not. This is especially important if you are young and healthy: You are more likely to get the coronavirus without showing symptoms, but can still spread it to someone who is older or who has a a chronic illness.

I’m worried I’ll look silly.

The more people wear masks, the more normal it will become, and the more the people around you will decide to wear masks, too. If you don’t want to look clinical, make your mask out of bright colors; or use a bandana or scarf. Be confident–nobody questions somebody who looks like they know what they are doing!

When should I wear a mask?

Wear a mask anytime you go somewhere frequented by people outside your household.

Can I go outside without a mask?

Being outdoors without a mask is safe if you stay away from other people. In fact, spending time outdoors is very important–without sunshine, you can get Vitamin D deficiency, which can weaken your immune system.

Where do I get a mask?

If you can’t buy surgical masks, you can make your own. There are plenty of patterns on the Internet. Here are some patterns we are currently sewing to be used as backups for health-care workers: https://sewmasks4cincy.org/

If you can’t sew, contact someone who can. Wash home-made masks coming from another household before wearing them.

Mask Safety:

1. Don’t share masks with other people. One per person.

2. Know which side of your mask is the outside, and which is the inside. Never put the outside of the mask against your face. If your mask looks identical on both sides, mark it so you know which is which.

3. Wear the mask correctly. It needs to go over both your mouth and nose, and snugly fit your face so that you are breathing through it, not around it.

4. If using disposable masks, dispose of them after wearing them once. If you have a cloth mask or bandana, wash it in soap and hot water. Soap breaks apart the virus, killing it.

5. When you take off the mask, do so gently and without letting the outside of it make contact with your face. Don’t swing it around in the air; that could fling virus into your environment.

6. Masks don’t work as well if they get wet, either from your breath or from rain. If it’s wet, switch it out for a new one.

7. Don’t let wearing a mask make you overconfident. Your mask helps keep others safe, but you still need to wash your hands and keep your distance to protect yourself.

8. Tie your mask securely, so you aren’t reaching up to adjust it. Adjusting your mask means touching your face, and as you know, touching your face can transfer virus from your hands to your face. If you find you tend to mess with your mask, unlearn the habit before it gets established.

To those who can sew:

Please be willing to pitch in and help your neighbors. Don’t charge for the masks you make–nobody should have to go without one because they are choosing between that and their dinner. If you are low on cloth, request that people give you their pillowcases and sheets–100% cotton and tightly woven–for you to make into masks. Remember that any object you receive from another household must be washed before you work with it; so toss those sheets straight into the laundry. When you give a mask to someone else, put it into a ziplock bag, sanitize the outside of the bag, and instruct them to wash their mask when they receive it.

Where do you get your information?

This is information I have gathered from the WHO, CDC, and from medical doctors. Sew Masks 4 Cincy provides masks to hospitals, but acknowledges that home-made masks are inferior to manufactured ones and are to be used only in case of shortage.

Remember:

Protect your neighbors! Wear a mask!